USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1949 > Part 62
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Registered No.
[(If death occurred in a hospital or institution,
St. [ give its NAME instead of street and number)
Flora Porter Fang 2 FULL NAME .. (If deceased is a married, widowed or divorced woman,(give also maiden name.) 44 Burch Road, Writhrope St. (If nonresident, give city or town and State)
(a) Residence. No. (Usual place of abode)
Length of stay: In place of death. years .. months. 2 days. In place of residence 36 .years ......... months .... ( . days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF December
11
1949
DEATH
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
nr.29
19
to ..
December 11.
19 44
I last saw her alive on
Decomber 11, 1944 death is said to
have occurred on the date stated above, at
1:108
m.
INTERVAL BE-
11 IF STILLBORN, enter that fact here.
12
AGE 68
Years
3. .. Months
22 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)
MSS
17 NAME OF FATHER Bryant
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Unable to obtain
Date of operation
Was autopsy performed?
710
What test confirmed diagnosis?
Clinical + X ray
5 Was disease or injury in any way related to occupation of deceased?
If so, specify ..
(Signed) Dorothy Chaney
applitom
....
(Address) 197 Who dudy June Date Decli
+9
M. D.
20 BIRTHPLACE OF
MOTHER (City)
Natick
6 ... Edgill Grove~ ~~ Framingham Place of Burial or Cremation (City or Town)
DATE OF BURIAL
Dec
13
49
19
7 NAME OF
FUNERAL DIRECTOR ..
FOR Lawand S Jund
ADDRESS aminos mais
Received and filed. DEC 15 1949
19
(Registrar)
PARENTS
19 MAIDEN NAME
OF MOTHER
Minnie Winch
(State or country)
Mass.
21 Russell A Lang
Informant (Address) 44 Birch Ra. 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 A. Balesiog (Signature of Agent of Board of Health or other) Realite Officer 12/13/19
(Official Designation) (Date of Issue of Permity
(write the word)
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Married
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Russell A Lang
(Husband's name in full)
DISEASE OR CONDITION
Veritonitis with
DIRECTLY LEADING
TO DEATH (a)
Intestinal Obstruction
TWEEN ONSET AND DEATH
13 das
ANTE
Due To Mesenteric Thumbauch
CEDENT (b)
CAUSES
Arecenteric
13 das
Due To
(c)
15 yrs
Natick
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations
8 SEX
Female
White
9 COLOR OR RACE
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
STRUCTIONS FOR AL CERTIFICATE
n giving E OF DEATH not enter e than one se for each , (b) and (c)
is does not mean e of dying, such failure, asthenia, means the disease, plications which eath.
bid conditions, giving rise to the use (a) stating derlying cause
ditions contrib- the death but not o the disease or causing death.
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 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, Scc. 6., as amended by Chap. 632, Scc. 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 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 occupz- 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
M R-301A 1
PLACE OF DEATH
Winthrop (City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN, SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
600
No.
Pelomena Campagna 2 FULL NAME ..
(If deceased is a married, widowed or divorced woman, give also maiden name.)
196 Marie St
St.
(If nonresident, give city or town and State)
Length of stay: In place of death. .years.
5
months. days. In place of residence. ...... .years.
.months .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
12/13/49
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY.
10/24
19.
49
to
12/13/49.
19
That I
, attended deceased from
I last saw has
.alive on
12/13/
49
.. 19
death is said to
have occurred on the date stated above. at
3 20 pm.
(Give maiden name of wife in full) 10a If married, widowed, or divorced HUSBAND of .. (or) WIFE of Epifanio Campagna
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 2 2 Years
Months
..
.Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation :
Home Work
(Kind of work done during most of working life)
14 Industry
or Business:
1, come
15 Social Security No. . mone
16 BIRTHPLACE (City) (State or country)
17 NAME OF FATHER Joseph racebene
18 BIRTHPLACE OF
Italy
19 MAIDEN NAME OF MOTHER nilicia 7 enbonanni
20 BIRTHPLACE OF MOTHER (City) (State or country)
21 Informant (Address) Comma Di Christerkovo 196 Paris St E. S.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or, transit permit was issued: Walter A. Baker (Signature of Agent of Board of Health/or other)
ADDRESS
Received and filed
DEC 20-1949
(Registrar)
8 SEX
Finale
9 COLOR OR RACE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widowed
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
INTERVAL BE- TWEEN ONSET AND DEATH 12/9/4
ANTE
CEDENT (b)
CAUSES
3 ys
(c) ..
3-4 40 3yrs
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
Date of operation
Was autopsy performed?
What test confirmed diagnosis?
clinical
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
Tanzen
(Signed)
(Address)
M. D.
238 husweet & Date 12/14 1949
a It Mechaltis
Place of Burial or Cremation
17
65 cation (City or Town)
DATE OF BURIAL
12
1/7/19
19
1
7 NAME OF
FUNERAL DIRECTOR .....
vincent
...... 19
J(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)
B
(a) Residence. No. (Usual place of abode)
STRUCTIONS FOR AL CERTIFICATE
n giving E OF DEATH not enter re than one se for each ), (b) and (c)
is does not mean le of dying, such failure, asthenia. neans the disease, plications which leath.
rbid conditions. giving rise to the use (a) stating derlying cause
ditions contrib- the death but not o the disease or n causing death.
PARENTS
50M-2-19-25666
T Suffolk (County)
Bralm
1/9/07
Registered No.
Health officer 12/16/49
"(Official Designation)
(Date of Issue { Permit)?
no FATHER (City) (State or country)
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 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 hy violence, or by the action of chemical, thermal or electrical agents or following abortion, or from discascs 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, Scc. 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 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 occup :- 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
1
PLACE OF DEATH
Suffolk 0(County)
Winthings (City or Town)
Withings Community Hospitals No.
J(If death occurred in a hospital or institution.
its NAME
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, NO
if so specify WAR)
(a) Residence. No. 6 Jefferson
St.
(If nonresident, give city or town and State)
Length of stay: In place of death. years months .. .days. In place of residence 65.years .months. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
December (Month)
14 (Day)
1949
(Year)
8 SEX
male
white
9 COLOR OR RACE
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED married
10a If married, widowed, or divorced
HUSBAND of.
Aggie Barclay
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 8.7
Years
5
Months
23 Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation:
retired
(Kind of work done during most of working life)
14 Industry
or Business: .
lobster business
15 Social Security No.
none
16 BIRTHPLACE (City)
(State or country)
Duxbury ass.
OTHER SIGNIFICANT CONDITIONS
Major findings:
Of operations.
Date of operation.
What test confirmed diagnosis?
Was autopsy performed? Clinical
no
5 Was disease or injury in any way related to occupation of deceased ?. 710
If so, specify ...... . Dorothy Cheney appleton M. D. (Address) 197 Woodand@
6 Winthrop Cemetery , Winthrop Mass Place of Burial or Cremation
DATE OF BURIAL ... December 17 1949. 19
7 NAME OF
FUNERAL DIRECTOR
alfred B. March
ADDRESS 174 Winthrop St, Winthrop, Mass.
19
Received and filed DEC 20 1949
(Registrar)
PARENTS
18 BIRTHPLACE OF
Duxbury
FATHER (City) (State or country) Mass.
19 MAIDEN NAME OF MOTHER Marie Drake
20 BIRTHPLACE OF
Duxbury
Mass
21 Informant. DefneE ...... Baker
(Address) 25 Edgehill Rd Winth&P
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter A Bakery.
(Signature of Agent of Board of Health or other)
Health Officer 12/19
(Official Designation) (Date of Issue of Permit)
To be filed for burial permit with Board of Health or its Agent.
201
Registered No. ..
num
2 FULL NAME
arthur
Baker
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Usual place of abodey
19 449
to Nec 17
19 49
I last saw him alive on
Der 14
19 49, death is said to
have occurred on the date stated above, at
10:00 A.m.
INTERVAL BE-
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Brasicho Inumma
TWEEN ONSET AND DEATH
2 das
ANTE
General arteriosclerosis
CEDENT (b) CAUSES
Due To (c)
SOM-2-19-25666
M R-301A 1
TRUCTIONS FOR L CERTIFICATE giving : OF DEATH not enter e than one e for each (b) and (c)
s does not mean e of dying, such failure, asthenia, cans the disease, lications which eath.
bid conditions. iving rise to the use (a) stating erlying cause
ditions contrib- he death but not the disease or causing death.
17 NAME OF FATHER Henry Baker
Date 12/14 1944 MOTHER (City) (State or country)
That I attended deceased from
AI HEREBY CERTIFY,
Dec. 12
17 hours
The Commonwealth of Massachusetts EDWARD J. CRONIN, SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
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