Town of Winthrop : Record of Deaths 1961, Part 3

Author: Winthrop (Mass.)
Publication date: 1961
Publisher:
Number of Pages: 542


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 3


Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).


Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39 | Part 40 | Part 41 | Part 42 | Part 43 | Part 44 | Part 45 | Part 46 | Part 47 | Part 48 | Part 49 | Part 50 | Part 51


Did injury occur in or about home on farm, in industrial place, or in public place?


Manner of -(Specify type of place)


Injury


(How did injury occur?)


Nature of


Injury


While at work?


Was autopsy performed?


yes


6 Was disease or injury in any-way-related-to occupation of deceased ?.


If so, greify-y .t.Benson (Signed): 09 Lain St, Winchester 1-11-51 M.D.


Satidrept:+ Cometery NoDRAKinsan ... 19.


7 Place of Burial, or Cremation. 1 - 16City for Town).


DATE OF BURIAL.


8 NAME OF Alfred B. Marsh 19


FUNERALI DIRECTORthrop St., Winthrop, Mass: ADDRESS


Received and filed FEB 13 1561 19


(Registrar of City or Town where deceased resided)


PERSONAL AND STATISTICAL PARTICULARS


9 SEX Flemale


HP COLOR OR RACE


11 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word)


Married


11a If married, widowed, or divorced --


HUSBAND of.


A I Sir paidea paresof rifs in full)


(or) WIFE of


(Husband's name in full)


12 IF STILLBORN, enter that fact here.


55


27


AGE


Years.


Months.


Days


"If under 24 hours


Hours ........ Minutes


14 Usual


Occupation :


(Kind of work done during most of working life)


15 Industry


or Business:


own home


16 Social Security No ..


Eagerstown


17 BIRTHPLACE (City).


(State or country)


Mass.


18 NAME OF rancis Joseph Marshall FATHER


PARENTS


19 BIRTHPLACE OF


FATHER (City)


(State or country)


Mass.


20 MAIDEN NAME


Charlotte Bearse


OF MOTHER


21 BIRTHPLACE OF


MOTHER (City)


Mass ..


(State or country)


Albert Walter Howe


22 Floyd St., Winthrop, Mass.


Informant.


(Address)


A TRUE COPY.


Elsie M. Nelson


ATTEST:


(Registrar of City or Town where death occurred)


DATE FILED 1-17-61 19 --


WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time C


after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) of death should be transmitted on Form R-305 to the clerk of the city or town in which the deceased resided as soon as possible


25M-5-52-907046


PLACE OF DEATH


ORM R-305 -


No.


Winchester Hospital


(Was deceased a


no


St.


13


housework


none


Hyannis


RECEIVED


TOWA


OF


11.02.


TiLERI


3


0


MASS.


FEB 1 31961 AM


1


1


RM R-301A 1


NSTRUCTIONS FOR . CAL CERTIFICATE


In giving SE OF DEATH


do not enter ore than one use for each a), (b) and (c)


s does not mean mode of dying, os heart foilure, mia, etc. It means isease, or compli- which caused


ditions, if any, ch gove rise to tue cause (o), ing the under- g couse lost.


onditions contrib- to deoth but not l to the terminal e condition given


e :- Chapter 137, of 1954. requires cians to print or the cause or s of death on certificates, and er 48, Acts of requires Physi- to print or type under signature.


M-11-59-926662


PLACE OF DEATH


Winthrop (City or Town)


76


The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS


STANDARD


CERTIFICATE OF DEATH


Registered No.


11


Summit Avenue


S(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)


76 Summit Avenue


St.


20 (If nonresident, give city or town and State) 8


Length of stay: In place of death .............. years. 8 months. 20 days. In place of residence .............. years ... months .days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


January


16,


1961


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY,


60


April 27,


19


to


January 16.


19.67


I last saw h .. . lalive on


January


16


61


19 ...


death is said to


have occurred on the date stated above, at


10:15 a. m.


INTERVAL


BETWEEN


ONSET AND


DEATH


83mos.


Due To (b)


Due To (c)


OTHER


Abdominal ascites


3 wks.


SIGNIFICANT


CONDITIONS


Was autopsy performed ?


no


What test confirmed diagnosis ?


Clinical & Laboratory


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


(Signed) Me, Traunstein .. , M. D.


M. Traunstein, Jr., M. D. 1/


(PRINT OR TYPE SIGNATURE)


(Address) 73 Bartlett Rd. Date. Jan. 16.161


FOREST


6


Place of Burial or Cremation


DATE OF BURIAL


Jan


18


7 NAME OF


FUNERAL DIRECTOR


William H ButlER


ADDRESS 50 ALBION ST, WAKEFIELD, MASS


Received and filed JAN 1 3 1991


19


(Registrar)


PARENTS


19 MAIDEN NAME


OF MOTHER


ROBERTA E. R.lEy


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


MASS


Boston


21 MRS ROBERTA E SCHIlle


Informant


76 Summit AVE, WAnthrop


I HEREBY CERTIFY that a satisfactory"standard certificate of death was filed with me BEFORE the burial or/transit permit was issued: Malph E. Vercanne (Signature of Agent of Beard of Health or other) 1/ 16/6/


40 .7


(Official Designation) (Date of Issue of Permit)


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 ...... ) .... Years


8


Months


20 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.


· WINTHROP


16 BIRTHPLACE (City)


(State or country)


MASS


17 NAME OF


FATHER


William S. SCHillE


18 BIRTHPLACE OF


FATHER (City)


Stratford


(State or country)


Conn


Winthrop Mass WAKEFIELD (City or Town) 1961


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


FEMALE


9 COLOR


white


10 SINGLE


MARRIED


WIDOWEINING/E


or DIVORCED


(write the word)


2 FULL NAME


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


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


No. NANCY MARY SCHILLE


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


INSF PF TID


X Suffolk (County)


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


(a)


Myelomeningocele with


hydrocephalus


That I attended deceased from


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


RULES OF PRACTICE


The fulfillment of the purpose of these laws calls for the observance of the following 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 un- related 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 occu- pation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.


ERK


3


MIN


* WIN


OFF


AV 19619 H Ner


>Statement of Cause of Death .- Physicians: see explanatory instructions face side of standard certificate of death.


COstatement of Occupation .- Precise statement of occupation is very impor- went, so that the relative healthfulness of various pursuits can be known. Make me entry in this section for every person aged 10 years or over. If the occupa. mon had been given up or changed, or if the deceased had retired from business, mtport the kind of work done during most of working life even if retired. Chil- dren 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. "Hor a person engaged in domestic service for wages, however, designate the Doccupation by the appropriate terms, as housekeeper-private family, cook- hotel, etc. For a person who had no occupation whatever write none.


Feta


ORM R-304


In giving CAUSE OF ETAL DEATH do not enter more than one cause for each of (a), (b) and (c)


tal or maternal ndition causing tal death (do ot use such rms as stillbirth prematurity. ) tal and/or ma- nal conditions, any, which gave se to above use (a), stating e underlying; use last.


onditions of fetus mother which ay have contrib- ed to fetal ath, but, in so r as is known, ere not related cause given (a).


5M-6 -60-928241


Suffolk (County , PLACE OF DELIVERY No. Winthrop Community Hospital, Winthrop


The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS CERTIFICATE OF FETAL DEATH ( STILLBIRTH)


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


Registered No.


12


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


3 DATE OF


DELIVERY


Jan. 17, 1961 Month


( Day )


(Year )


4 SEX


Male . .. FemaleX .. Undetermined


...


5 COLOR (if


determined) W


6 THIS BIRTH (Check one) Single A Twin Triplet.


7 IF MULTIPLE BIRTH, BORN : 1st.


.2nd .3rd


FATHER


8 FULL NAME Alfred D. Sera


9


RESIDENCE, NO.


CITY OR TOWN


105 Garfield Avenue


Chelsea


STREET


STATE


Mass.


15 RESIDENCE, NO. CITY OR TOWN


105 Garfield Avenue Chelsea


STATE


STREET Mass.


10 COLOR OR


RACE. ..


White


11 AGE AT TIME O"


THIS DELIVI


37


16 COLOR OR RACE


White


17 AGE AT TIME OF THIS DELIVERY


35


(Years)


12 PLACE OF


BIRTH


E. Boston, Massachusetts


(City or Town |


(State or country


18 PLACE OF


BIRTH


Medford, Massachusetts (City or Town) State or country )


13 OCCUPATION Accountant


19 INFORMANT


Mother


20 PREVIOUS DELIVERIES TO MOTHER (Do not include this fetus ) Six


(a) How many children are now living ?


6


23 WHEN DID FETUS DIE? Before X Labor


24 AUTOPSY


Yes


.No


X


25 FETAL DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) Placenta Previa


Due To (b) Premature Separation of Placenta Due To (c)


OTHER SIGNIFICANT CONDITIONS


None


26 woodlawn, Place of Burial or Cremation


DATE OF BURIAL Jan. 15,


Everett (City or Town) 61


27 NAME OF FUNERAL DIRECTOR Johnt, Welsh 718 Broadway Chels() ADDRESS


Received and filed 19


Registrar )


I HEREBY CERTIFY that this delivery occurred on the date stated A. above at 12:30 m. and product of conception was not a live birth.


Signature ding Physician or Medical Examiner : a. Paul Delta joplin


. M.D.


A. Paul DerHagopian, M.D. (PRINT OR TYPE SIGNATURE)


Address


39 Cary Ave., Chelseaate


1/17/ .19 ... 61


I HEREBY CERTIFY that a satisfactory certificate of fetal death was filed with me BEFORE the burial or transit permit was issued : .


Ralph E. Seriaum Signature of Agent Cuff board of Health or other) HO 1/18/6/ X


(Official Designation ) ( Date of Issue of Permit


A TRUE COPY ATTEST :


14 MAIDEN NAME


(b) How many children were born alive but are now dead ? O


(c) How many previous fetal deaths of ANY gestation age ? 0


21 LENGTH OF PREGNANCY 6 mos, .completed weeks


22 WEICHT OF FETU 2 - Lb. Oz


(or


Grams )


During Labor


or Delivery.


Unknown


MOTHER Kathleen T. Griffin Kathleen T. Sera


PRESENT NAME


St.


2 NAME OF FETUS (if given)


Premature Female Sera


1 Winthrop (City or Town)


RECEIVED


FETAL DEATH


TOWN


OFFICE OF


11 12


10


MIN


00


5


6


AS


WIT


THRO


JAN 1961 AM


EXTRACTS OF CERTAIN SECTIONS OF CHAPTER 46 AS AMENDED OR ADDED BY CHAPTER 48. ACTS OF 1960.


Section 2A. "Examination of records and returns of illegitimate births, or abnormal sex births, or fetal deaths, ... shall not be permitted except ... ".


Section 9A. When a child is born dead, after a period of gestation of not less than twenty weeks, and in the fetus there is no attempt at respiration, no action of heart and no movement of voluntary muscle, the physician or officer attending at the birth of such child shall forthwith furnish for registration, at the request of an undertaker or other authorized person or of any member of the family of the deceased, a certificate of fetal death on a form which shall be prepared by the secretary of state as required by section sixteen. Town clerks shall record certificates of fetal death in the town register of deaths in the same manner as a death certificate, but they shall not be required to record such certificates in the town register of births.


Section 12. " ... No birth record of a child born out of wedlock or of a child of abnormal sex, and no record of fetal death shall so be transmitted to any other city or town."


Section 24. In any statement of births, deaths and fetal deaths printed by a town the name of an illegitimate child or of its parents or of the parents of a child born dead shall not be printed, but the word "illegitimate" or "fetal death" shall be used in place thereof. A town violating this section shall forfeit to the mother of such child not more than one hundred dollars.


1/ 19


the of certi


23 pr inder


re Ise


1 1: E


UM R-301A 1


ITRUCTIONS FOR IL CERTIFICATE


1 giving rs OF DEATH d not enter ne than one ale for each (a) (b) and (c)


isdoes not mean a. de of dying, heart failure, m1 etc. It means Hiise, or compli- which caused


tions, if any, gave rise to cause (a), the under- cause last.


Iditions contrib- death but not do the terminal condition given )


o :- Chapter 137, f 1954. requires ians to print or the cause or of death on certificates, and yer 48, Acts of Drequires Physi- mito print or type under signature.


AU.C.


0-928145


PLACE OF DEATH


Suffolk (County)


INSEPE


Winthrop


(City or Town)


The Commonwealth of Massachusetts JOSEPH D. WARD 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. 13


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


PHYSICIAN - IMPORTANT


2 FULL NAME


Mary.A ..... McGillicuddy


(First Name)


(Middle Name)


(Last Name)


(if so specify WAR)


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


39 Pico. Avenue


St.


(If nonresident, give city or town and State)


Length of stay: In place of death ..


.years.


.months.


days.


In place of residence.


years.


months ............ days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Female


9 COLOR


White


10 SINGLE


MARRIED


WIDOMarried


or DIVORCES


10a If married, widowed, or divorced HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


.WilliamH ........ McGillicuddy


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


If under 24 hours


AGE


70


İYears


Months.


Days


Hours ..........


... Minutes


13 Usual


Occupation :


Housewife


(Kind of work done during most of working life)


14 Industry


or Business :


Q.wn ..... Ho.me.


15 Social Security No.


No.n.c


Everett


16 BIRTHPLACE (City) (State or country) Mass


17 NAME OF


FATHER


William Harron


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Ireland


19 MAIDEN NAME


OF MOTHER


Mary J. Meakin.


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Ireland


21


Nancy Mcgillicuddy


Informant


(Address)


39 Pico Ave., Winthrop


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me/ BEFORE the burial or transit permit was issued: Talalà Sercemne (Signature of Agent of Board of Health or other)


110 Jan 21, 1961


(Official Designation)


(Registrar)


PARENTS


6 Winthrop Cemetery Winthrop


Place of Burial or Cremation (City or Town)


DATE OF BURIAL January 23 61


19


7 NAME OF


FUNERAL DIRECTOR


Arthur J. O'Maley


ADDRESS Winthrop Mass.


Received and filed


JAN-24 1961


...... 19


61


I last saw but alive on


1/19


61


death is said to


have occurred on the date stated above, at


4. 45Pm.


.. m.


INTERVAL


BETWEEN


ONSET AND


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


BRONCHO-PNEUMONIA


UDS DEATH


(a)


Due To


(b)


CEREBRAL


5 mg


Due To


THROMBOSIS


(c)


OTHER


SIGNIFICANT


CONDITIONS


Was autopsy performed?


What test confirmed diagnosis?


0


5 Was disease or injury in any way related to occupation of deceased? If so, specify


(Signed)


the o'Resan


M. D


FRED O REGAIN MID


PRINT OR TYPE SIGNATURE)


113 PLEASANT


Date 1/20 10 61


(Address)


WINTHROP


3 DATE OF


January 19 1961


DEATH


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY


Dec 18, 1960


to.


1/19


That I attended deceased from


(write the word)


(a) Residence: No. .


(Usual place of àbode)


50


[(Was deceased a


U. S. War Veteran,


No


No.


.WinthropCommunity Hospital


(Date of Issue of Permit)


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


12 1.


SERVICE NUMBER


OFFIC


10


2 ...


5


6


THROP MASS.


RULES OF L CTICE


The fulfillment of the purpose of these laws calls for the observance of the following rules of practice : JAN 2 41961.4H persons (1) Attending physicians will ff to whom they have given bedside care during a last illness from disease un- related 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 occu- pation, 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 impor- tant, 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. Chil- dren 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.


to


----


CLERK


X PLACE OF DEATH


Suffolk


(County) winthrop


(City or Town)


20 Lewis Avenue


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. 13


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


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


25 Parkman


St.


Brookline, Mass.


(If nonresident, give city or town and State)


Length of stay: In place of death


years


3


months


days. In place of residence ..:


years


months.


days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


January 201961


DEATH


(Month) (Day)


(Year)


8 SEX


female


white


9 COLOR


10 SINGLE


(write the word)


MARRIED


WIDOWED


Or DIVORCED Widowed


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


Joseph Rosen


(or) WIFE of


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


68


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)


Poland


17 NAME OF


FATHER


Morris Rosen (O.K.)


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Poland


19 MAIDEN NAME


OF MOTHER


(unknown)


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Poland


Pride of Jacob, Wixt West Roxbury


6


Place of Burial or Cremation


DATE OF BURIAL


January


22,


(City or Town)


19 ...


61


7 NAME OF


FUNERAL DIRECTOR


430 Harvard Street, Brookline


ADDRESS


Received and filed JAN 2-4-1961 19


(Registrar)


PARENTS


21


Estelle Cohen


Informant


(Address) 20 Lewis Avenue, Winthrop, Mass.


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the buyfal or transit permit was issued: Kalff E Serianni Cafenature of Agent of Board of Health or other) Jan 21-1961


(Official Designation) (Date of Issue of Permity


X


STRUCTIONS FOR AL CERTIFICATE


In giving UE OF DEATH not enter gre than one cise for each ), (b) and (c)


Ts does not mean ode of dying, s heart failure, ti, etc. It means ease, or compli- which caused


Itions, if any, gave rise to cause (a), 5 the under- cause last.


- (b)


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


Was autopsy performed?


no.


What test confirmed diagnosis? Clinical & cytological


5 Was disease or injury in any way related to occupation of deceased ? NO Ernst Cohn, M. D.


(Signed)


39 Columbia Road, Dorchester


Datalan.21,


19.61


M. D.


(Address)


50M-5-57-920345


No.


2 FULL NAME Bertha Rosen


PHYSICIAN - IMPORTANT


-


(Was deceased a


U. S. War Veteran,


no .


if so specify WAR)


(a) Residence. No.


(Usual place of abode)


4 I HEREBY CERTIFY,


Apr.21,


610


That I attended deceased from


Jan. 18,


19


61


I last saw h .__._. alive on


er


19


61


to


Jan.18


19


, death is said to!


have occurred on the date stated above, at


6 a. m.


INTERVAL


BETWEEN


ONSET AND


DEATH


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) Carcinoma of the ovarium


1 yr.


metastic to abdomen


METASTETTE Due To


Housewife


Oditions contrib -- > Bo death but not to the terminal condition given


:- Chapter 137, Bf 1954, requires mians to print or the cause or of death on certificates.


CRM R-301A 1


17 ---


Benjamin F.Solomon


30


PERSONAL AND STATISTICAL PARTICULARS


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, eightcen 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




Need help finding more records? Try our genealogical records directory which has more than 1 million sources to help you more easily locate the available records.