USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1949 > Part 25
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Was autopsy performed?
200
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased? No
If so, specify
Louis 7 Salerno
M. D.
(Signed).
(Address) 175 Pleasant St
6
Winthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL.
June
21
49
19
7 NAME OF
FUNERAL DIRECTOR
Stoward SOSmolto
ADDRESS Winchop mais.
Received and filed 19
JUN .2.3.1949
(Registrar)
PARENTS
17 NAME OF
FATHER
Isaiah C Doane
18 BIRTHPLACE OF
FATHER (City)
Wellfleet
(State or country)
Mass.
19 MAIDEN NAME
OF MOTHER
Joanna Chipman
20 BIRTHPLACE OF
MOTHER (City)
Wellfleet
(State or country)
Mass.
21
Informant
(Address)
5I Palmyra St Winthrop, Mas:
Eunice E Doane
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Waiter & Baker (Signature of Agent,of Board of Health or other)
Health Mick
6/21/49
"(Official Designation)
(Date of Issue of Permit)
RUCTIONS FOR . CERTIFICATE
giving OF DEATH not enter than one for each (b) and (c)
does not mean of dying, such ilure, asthenia,. ans the disease. ications which 3th.
id conditions. ving rise to the se (a) stating rlying cause
itions contrib- e death but not the disease or causing death.
100M-(D)-10-48-24658
1 yr
ANTE
Due To
CEDENT (b)
CAUSES
Due To (c)
If married, widowed, o HUSBAND of .. (Give maiden name of wife in full)
Etthice E Brown
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Carcinoma of Prostate
3 DATE OF
DEATH
June
18 .
1949
(Month)
(Day)
(Year)
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR)
(a) Residence. No. (Usual place of abode)
No. 51 Palmyra Street
Date June 18/1949
Winthrop
Date of operation
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 n 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 aw, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the
death certificate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate. shall forthwith countersign it and transmit it to the clerk of the town for registra- tion. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114. Sec. 45. G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence. If a medical examiner has notice that there is within his county the body of such a person, he shall forthwith go to the place where the body lies and take charge of the same; . General Laws, Chap. 38, Sec.6.
No undertaker or other persons shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made.
Chap. 114, Sec.46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the follow- ing rules of practice :
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very import- ant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business. report the kind of work done during most of working life even if retired. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No. 82
J(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME .. Francis Henry Simpson
(If deceased is a married, widowed or divorced woman, give also maiden name.)
960 Shirley Street
St.
(If nonresident, give city or town and State)
Length of stay: In place of death . years . .. .. months. days. In place of residence 3 .years .. months .days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF DEATH ..
UNE (Month)
19 - 1949 (Year) (Day)
4 I HEREBY CERTIFY,
That I attended deceased from
Sept. 8 19
47
to.
C
10
1949. death is said to
7th P.m.
have occurred on the date stated above, at INTERVAL BE- TWEEN ONSET AND DEATH 15 days 11 IF STILLBORN. enter that fact here. 12 AGE . 79Years 10 Months 6 Days
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Cerebral HEmoralago
ANTE Due To arterioscleratic and (b) CEDENT CAUSES hypertensive heart disease
(c) Generalized atEro- a devario
2 years
OTHER
SIGNIFICANT
CONDITIONS
none
Major findings:
Of operations.
Date of operation
Was autopsy performed?
What test confirmed diagnosis?
Clinical + laboratory
5 Was disease or injury in any way related to occupation of deceased? Ko If so, specify (Sigr Maurice Traunstein . M. D. (Address) 56> Shebey ST. Whathon Datl Jande 1/1949 Mt. Hope Boston
6
Place of Burial or Cremation
(City of Town)
DATE OF BURIAL.
June
. 22
1949
7 NAME OF
FUNERAL DIRECTOR
ADDRESS
Received and filed. 19
JUN 23 1949
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR OR RACE
10 SINGLE
(write the word)
Male White
MARRIED
WIDOWED
of DIVORCEDWidowed
10a If married, widowed, or diver
HUSBAND of
lorence Swett
(Give maiden name of wife in full)
If under 24 hours
Hours . . Minutes
13 Usual
Occupation:
Maintanence
(Kind of work done during most of working life)
1 year
14 Industry
or Business:
Department Store
15 Social Security No. 031-05-8207A
.Boston
16 BIRTHPLACE (City).
(State or country)
Mass
17 NAME OF FATHER Henry Simpson
18 BIRTHPLACE OF
no FATHER (City) Boston
(State or country)
Mass
19 MAIDEN NAME
OF MOTHER
Sarah Carpenter
20 BIRTHPLACE OF
MOTHER (City)
Marbe The ad
(State or country)
Mass
21 Informant Eva Whitney (Address 960 Shirley St. Winthrop, Mass
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter &. Bakerz (Signature of Agent of Board of Health or other}
6/21,49
(Official Designation)
(Date of Issue of Permit) /
TRUCTIONS FOR L CERTIFICATE
giving OF DEATH not enter than one e for each (b) and (c)
does not mean of dying, such ailure, asthenia, eans the disease, lications which ath.
bid conditions. ving rise to the se (a) stating erlying cause
litions contrib- he death but not the disease or causing death.
PARENTS
100M-(D)-10-48-24656
M R-301A 1
No. 960 Shirley Street
........
(Was deceased a U. S. War Veteran. if so specify WAR)
(a) Residence. No. (Usual place of abode)
June
19
19
49
I last saw
hemalive on ....
(or) WIFE of
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 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 only such persons as are supposed to have died by violence. If a medical examiner has notice that there is within his county the body of such a person, he shall forthwith go to the place where the body lies and take charge of the same;
. General Laws, Chap. 38, Sec.6.
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 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
RM R-305 1
PLACE OF DEATH
SUFFOLK (County) BOSTON
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
SONTOK
(City or town making return)
Registered No.
54783
No.
Mass. Eye & Ear Infirmary
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.) 30 Underhill St
St.
(If nonresident, give city or town and State)
Length of stay: In place of death
years ..
.months.
1
days. In place of residence
35
years
months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
(Month)
June 22/49
(Day)
(Year)
9 SEX
M
10 COLOR OR RACE
W
11 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widowed
4 I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was- Carcinoma of l'aryfx occlusion of Larynx
11a If married, widowed, or divor@race G Burke
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
13
AGE .. 65 Years.
Months.
Days
If under 24 hours
Hours .....
Minutes
14 Usual
Occupation 1.
Tax Accountant
(Kind of work done during most of working life)
15 Industry
or Business:
Self
16 Social Security NoNone
17 BIRTHPLACE (CS), Portland Maine (State or country)
18 NAME OF
FATHER
Edwin Nichols
19 BIRTHPLACE OF
FATHER (City).
Lewisport Maine
(State or country)
20 MAIDEN NAME
OF MOTHER
Helen Pingree
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
Portland Maine
Winthrop em-Winthrop
"ass.
7 Place of Burial, or Cremation. June 25/49
(City or Town)
M Nichols
DATE OF BURIAL
19
8 NAME OF
Maurice Kirby
FUNERAL DIRECTOR
Winthrop Mass
ADDRESS.
Received and filed.
JUL 1 .... 1949
19
(Registrar of City or Town where deceased resided)
A TRUE COPY center
ATTEST:
(Registrar of City or Town where death occurred
DATE FILED
June 27/49 0
19
...
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 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 Injury
25m-(h)-10-48-24658
5 Accident, suicide, or homicide (specify).
Date and hour of injury. 19
Where did Injury occur? (City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in public place?
Manner of
Collapsed suddenly
(Specify type of place) and died
Injury
Nature of
quicklywifiniey tourhospital
While at work?
Was autopsy performed? . No.
6 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
w J Brickley
M. D.
(Address)
Boston Mass
Date ...
6=22
19 49
19
PARENTS
22 Informant (Address)
1
2 FULL NAME ..
"Frank" Nathaniel F.R. Nichols
(Was deceased a
U. S. War Veteran,
if so specify WAR)
Winthrop
Mass.
(a) Residence.
No.
(Usual place of abode)
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
M R-301A 1
PLACE OF DEATH
Suffolk (County) Sinchirp (City or Town) Winchup Com. Hosp
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
Registered No.
81
[(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.) 95 Terrace Are. St.
(a) Residence. No. (Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death.
5hrs 29 min
months.
«days. In place of residence.
.. years
.months
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Sune
2-3
1949
'(Year)
8 SEX
Female
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Vingle
4 I HEREBY CERTIFY,
That I attended deceased from
19.
to
19
I last saw h ..........
.alive on
19 ...
death is said to
have occurred on the date stated above, at 4:36 Am.
INTERVAL BE-
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Prematurity
Il veigit 3,0
Due To
iremotore seco. 1
ANTE
CEDENT
(b)
CAUSES
+ secanta
Due To
(c) ..
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations
Date of operation
.Was autopsy performed?
What test confirmed diagnosis ?.
5 Was disease or injury in any way related to occupation of deceased? -
If so, specify
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