USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1950 > Part 10
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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 discases resulting from injury or infection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead. . - General Laws, Chap. 38, Sec. 6., as amended by Chap. 632, Sec. 4. Acts of 1945.
No undertaker or other persons shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made.
. Chap. 114, Sec.46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the follow- ing rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very import- ant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT
SERVICE NUMBER
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-302 to the clerk of the city or town in which the deceased resided as soon as possible
PLACE OF DEATH
(City or Town) Gardner State Hospital No.
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Gardner
(City or town making return)
Registered No.
29
2 FULL NAME
Pliny Emerson, Jr.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a
U. S. War Veteran,
( if so specify WAR)
(a) Residence.
No.
(Usual place of abode)
7 Washington Ave.
St.
Winthrop,
Mass
(If nonresident, give city or town and State)
Length of stay: In place of death
2.2.years.
7
months.
12. days.
In place of residence
.years.
.months
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
February
26,
1950
(Month)
(Day)
(Year)
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
DIVORC
Single
4 I HEREBY CERTIFY,
Jan. 9
50
19
to
1,50
death is said to
have occurred on the date stated above. at.
1:45 p.m.
INTERVAL BE-
11 IF STILLBORN, enter that fact here.
63
12
AGE
Years
3
Month
25
.. Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation :
Bricklayer
(Kind of work done during most of working life)
14 Industry
or Business:
Building Contractor
15 Social Security No.
None.
16 BIRTHPLACE (City).
(State or country)
Millbury, Mass.
17 NAME OF
FATHER
Pliny Emerson
Major findings:
Of operations.
No operation
Date of operation
None
Was autopsy performed?
No
What test confirmed diagnosis ?.
Clinical Xray
NO
5 Was disease or injury in any way related to occupation of deceased? If so, specify Harry Goodman, M. D.
(Signed)
(Address) ... E. Gardner, Mas.S .... Date ..
2/26
.19.50
Woodlawn Cem. , Everett.
Mass.
Uxbridge. Com, Uxbridge(CityMaiss)
DATE OF BURIAL
March1
19
50
Informant
(Address)
Records
7 NAME OF
· DIRECTO Alfred B. Marsh
ADDRESS-
174 Winthrop St., Winthrop
Received and filed .19
(Registrar of City or Town where deceased resided)
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Rhode Island
19 MAIDEN NAME
OF MOTHER
Carrie Carter
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Rhode Island
21
Gardner State Hospital
A TRUE COPY.
Jarah G. Bourgeois
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
February .... 27,
.19
50.
IN
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
TWEEN ONSET AND DEATH 5
wks.
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Empy ema
ANTE
CEDENT (b)
CAUSES
Due To Bronchopneumonia
5 wks.
deceased
from
50
That I attended
Feb. 26
19
I last saw h.
im
.. alive on
Feb.
26
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
50m-(e)-10-58-24658
+ Worcester (County)
RM R-302 1 Gardner
J(If death occurred in a hospital or institution.
St. [ give its NAME instead of street and number)
·
1
IM R-302 1
PLACE OF DEATH'
SUFFOLK BOSTON (County)
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registered No.
1510 30
(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME.
Mary Mccarthy
(If deceased is a married, widowed or divorced woman, give also maiden name.)
Bay View Rest Home
St.
Winthrop Mass.
(If nonresident, give city or town and State)
Length of stay: In place of death
.. years.
.1months ..... 2 .... days. In place of residence
10
.years.
.. months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
F
9 COLOR OR RACE
W
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
4 I HEREBY CERTIFY,
Jan. 16 19 50
to
Feb. 18
19
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Peritonitis
INTERVAL BE-
TWEEN ONSET
AND DEATH
36 Hr
11 IF STILLBORN, enter that fact here.
12
90
Years
Months.
Days
If under 24 hours
Hours .....
Minutes
13 Usual
Occupation :
Home
(Kind of work done during most of working life)
14 Industry
or Business:
15 Social Security No ..
None.
16 BIRTHPLACE (City).
(State or country)
Boston Mass.
17 NAME OF
FATHER
Callahan Mccarthy
18 BIRTHPLACE OF
Ireland
FATHER (City)
(State or country)
19 MAIDEN NAME
OF MOTHER
Elizabeth -
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL.
Feb. 21/50
19
21
Informant
(Address)
A TRUE COPY
L
ATTEST:
(Registrar of City or Town where death occurred) A?
DATE FILED
Feb. 23/50
19
25m-(b)-11-49-900,475'
3 DATE OF
DEATH
ANTE
CEDENT (b)
CAUSES
6
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-302 to the clerk of the city or town in which the deceased resided as soon as possible
CONDITIONS
Feb. 18/50
(Month)
(Day)
(Year)
That
I attended deceased
from
50
I last saw h
er .. alive on
Feb. 18
. 19 50 death is said to
have occurred on the date stated above, at.
12;30P
m.
Due To
Perforating gastric
ulcer
Due To (c)
OTHER
Pulmonary edema
24 Hrs
SIGNIFICANT
Date of operation
2-2-50
. Was autopsy performed ?. Yes
What test confirmed diagnosis?
No
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
JE Fuchs
(Signed)
750 Harrison Avente 2-19"
M.
50
(Address)
Holyhood-Brookline Mass.
19.
PARENTS
7 NAME OF
FUNERAL DIRECTOR
M W Kirby
ADDRESS Winthrop Mass.
Received and filed
MAR 16 1990
19
(Registrar of City or Town where deceased resided)
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 WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
cc 6,0
Mass.Mem. Hospitals No.
(a) Residence. No.
(Usual place of abode)
(Was deceased a
U. S. War Veteran,
( if so specify WAR)
Mrs J L Wells
Major findings:
Of operations
Pyloric obstruction
1 Week
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.)
25m-(b)-11-49-900,475
×
PLACE OF DEATH
SUB
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BC
(City or town making return)
Registered No.
1458. 31
2 FULL NAME.
Katy Schwartz
(If deceased is a married, widowed or divorced woman, give also maiden name.)
39 Pearl Ave.
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay: In place of death.
2
.years
3
.months ...
.. days. In place of residence.
2
.. years.
3
months.
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Feb ...... 18,1950
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
July/48
19
to
2/18/50
That I attended deceased from
19
I last saw h.e.r.
alive on.
19
death is said to
have occurred on the date stated above, at.
5 35P
m.
INTERVAL BE-
TWEEN ONSET AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
heart disease
Arteriosclerotic
yrs
11 IF STILLBORN. enter that fact here.
12
AGE37
Years
Months.
Days
If under 24 hours
Hours.
Minutes
13 Usual
Housewife
Occupation:
(Kind of work done during most of working life)
14 Industry
or Business:
own home
15 Social Security No ..
16 BIRTHPLACE (City)
(State or country)
Russia
17 NAME OF
FATHER
Myer Flaxman
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Russia
19 MAIDEN NAME
OF MOTHER
Pearl
5 Was disease or injury in any way related to occupation of deceased?
If so, specify.
(Signed)
E G Margolin
M. D.
(Address)
45 Townsend St Date 2/18/500
6
Agudas Achim - Woburn
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
2/19/50
19
7 NAME OF
FUNERAL DIRECTOR
H J Toff
ADDRESS
Chelsea
Received and filed.
19
MAK
(Registrar of City or Town where deceased resided)
PARENTS
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
21
Informant
(Address)
19 Maple St. Rox
A TRUE COPY
OPY @farle
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
2/21/50
...... .19
.......
8 SEX
F
9 COLOR OR RACE
W
10 SINGLE
MARRIED
WIDOWED
of DIVORCED Wid,
(write the word)
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Isaac Schwartz
(or) WIFE of.
(Husband's name in full)
Due ToGeneralized arterio
ANTE
CEDENT (b)
CAUSES
sclerosis
Due To
(c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
none
Date of operation
Was autopsy performed?
no
What test confirmed diagnosis ?.
clin
of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible
.M R-302 1
(County)
Jewish Memorial Hosp No.
J(If death occurred in a hospital or institution,
St. [ give its NAME instead of street and number)
(Was deceased a
U. S. War Veteran,
( if so specify WAR)
(a) Residence. No.
(Usual place of abode)
...
2/18/50
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
Joseph Schwartz
X
PLACE OF DEATH
SUFFOLK
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
OSTON
(City or town making return)
1542
32
Registered No
Enroute to Mass.General Hospital
J (If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
37 Belcher St
St.
Winthrop Mass.
(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
PERSONAL AND STATISTICAL PARTICULARS
9 SEX
M
10 COLOR OR RACE
W
11 SINGLE
MARRIED
WIDOWED
or DIVORCED
Married
(Month)
(Day)
(Year)
4I 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 involved, state fully.) Coronary occlusion
d, widowed, or divorc
Rachael Gillespie
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
51 Years
Months.
Days
If under 24 hours
Hours
Minutes
14 Usual
Occupation :..
Engineer
(Kind of work done during most of working life)
15 Industry
or Business:
U.S. Gov't.
16 Social Security No.
Charlestown Mass.
17 BIRTHPLACE (City)
(State or country)
18 NAME OF
FATHER
Edward P Donahue
19 BIRTHPLACE OF
FATHER (City)
(State or country)
Boston Mass.
20 MAIDEN NAME
OF MOTHER
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
(Address)
25 Shattuck St
Date 2-21 19 50
Winthrop Cem-Winthrop Mass.
7 Place of Burial, or Cremation. (City or Town)
DATE OF BURIAL.
Feb. 24/50
19
8 NAME OF
FUNERAL DIRECTOR
J F Or Maley
ADDRESS Winthrop.Mass ..
Received and filed.
MAR.1.61950
19
(Registrar of City or Town where deceased resided)
PARENTS
6 Was disease or injury in any way related to occupation of deceased ?.
If so, specify.
(Signed)
Michael A Luongo
M. D.
25m-(h)-10-48-24658
place? Injury 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
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
1
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
(Specify type of place)
Manner of
(How did injury occur?)
Nature of
While at work?
.Was autopsy performed?
No
22
Informant.
(Address)
R Gillespie
A TRUE COPY.
ATTEST:
Charles & Mackie
(Registrar of City or Town where death occurred) Feb.23/50
DATE FILED
........
19
M R-305 1
No.
Edward J Donahue
(Was deceased a
U. S. War Veteran.
if so specify WAR).
(a) Residence. No. (Usual place of abode)
3 DATE OF
DEATH
Feb. 20/50
(write the word)
Elizabeth Sullivan
X
PLACE OF DEATH
SUFFOduty BOSTON (City of Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registered No.
1666 33
J(If death occurred in a hospital or institution, St. \ give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
74 Atlantic Ave.
St.
Winthrop Mass.
(a) Residence. No.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death ...
.. years.
months.
11
.days.
In place of residence.
......
.years.
.. months.
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
Feb. 24/50
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
F.e.b/13 .... ,
19 ... 50
...
to ..
Feb.24
19.50
I last saw h ...
im.alive on
Feb.24
19 50
death is said to
have occurred on the date stated above, at
3:29A
m.
INTERVAL BE-
TWEEN ONSET
AND DEATH
2 Mos.
11 IF STILLBORN, enter that fact here.
12
AGE82
Years
5
25
Months
Days
Hours .....
Minutes
13 Usual
Occupation:
Painting Contractor(R)
(Kind of work done during most of working life)
14 Industry
or Business:
Self Employed
15 Social Security No.
None
16 BIRTHPLACE (City)
(State or country)
Norway
17 NAME OF
FATHER
Christian Johnson
18 BIRTHPLACE OF
Norway
FATHER (City).
(State or country)
19 MAIDEN NAME
OF MOTHER
Johanna Tolleson
20 BIRTHPLACE OF
MOTHER (City)
Norway.
(State or country)
Anna Johnson
7 NAME OF
FUNERAL DIRECTOR
H S Reynolds
ADDRESS Winthrop Mass.
Received and filed MAR 2 3 1950 19
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
M
9 COLOR OR RACE
W
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
10a If married, widowed, or divorced
Anna Stange
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
Uremia
TO DEATH (a)
Due To
Carcinoma of Bladder
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Arteriosclerosis
Major findings:
Of operations.
Carcinoma of bladder
Date of operation.
1-5-50
Was autopsy performed ?..
.No
What test confirmed diagnosis? Operation & clinical
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
P Bonnet
M. D
Winthrop Cem-Winthrop Mass.
DATE OF BURIAL
Feb.27/50
19
21
Informant.
(Address)
A TRUE COPY
Charles & Mackie
ATTEST:
(Registrar of City or Town where death occurred) Feb. 28/50
DATE FILED
...... .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 WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
6 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-302 to the clerk of the city or town in which the deceased resided as soon as possible CAUSES
25m-(b)-11-49-900,475
(Signed)
(Address)
7.50 Harrison AVeDate .....
2-24 ..... 19 ....
Place of Burial or Cremation (City or Town)
PARENTS
If under 24 hours
ANTE
CEDENT (b)
22 Mos
Generalized
M R-302 1
No.
Mass.Memorial Hospital
John T Johnson
(Was deceased a
U. S. War Veteran,
if so specify WAR)
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.)
PLACE OF DEATH
Suffolk (County)
Boston (City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
ROSTO
(City or town making return)
Registered No. ..
1718 ..... 31
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
Robert H. Lambert
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 82 Waldemar Ave.
St.
Winthrop Mass
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death.
.years ...
months.
22days. In place of residence.
32 years
months.
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Feb.
26
(Month)
(Day)
(Year)
8 SEX
M
9 COLOR OR RACE
W
MARRIED
WIDOWEDSingle
or DIVORCED
4 I HEREBY CERTIFY,
That I attended deceased from
Feb. 4
19
50
to
Feb. 26
195Q
I last saw h.
im alive on F.e.b ......
26
19.5.0. death is said to
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADIA
TO DEATH (a)
Uremia
TWEEN ONSET AND DEATH 1 wk
11 IF STILLBORN, enter that fact here.
12
AGE.32 ... Years.
Months
Days
If under 24 hours
Hours.
Minutes
ANTE CEDENT (b)
Due To chronic
CAUSES glomerulonephritis
2 yr
U2
14 Industry
or Business:
Rubber industry
15 Social Security No ....
01/1-16-3060
2 yr
16 BIRTHPLACE (City).
Winthrop
OTHER
SIGNIFICANT
CONDITIONS
diabetes mellitus
20 yrs
17 NAME OF
FATHER
Matthew Lambert
Major findings: Of operations.
Date of operation.
.Was autopsy performed?
2-26-5
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased ?...... Q. If so, specify ..
(Signed).
Willaim J. Clark
M. D.
6
Winthrop.Cemetery
Winthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIALMarch .... ]
19.5.0
21
Informant
(Address)
A TRUE COPY
21 Imac
ATTEST:
(Registrar of City or Town where death occurred) March 1/50
19
.......
(Registrar of City or Town where deceased resided)
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
East Boston,
Masso
19 MAIDEN NAME
OF MOTHER
Leonara Hammond
20 BIRTHPLACE OF
Ellsworth
(Address Carne.y ..... Hosp.
Date. 2 .- 2.6
19.50
MOTHER (City)
(State or country)
Maine
M. Lambert
Brother
7 NAME OF
FUNERAL DIRECTOR
John F. O'Maley
ADDRESS.
Winthrop, Mass
1950
Received and filed.
MAR 2 3 1950
DATE FILED
of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible
WRITE PLAINLY, WITH UNFAVING BLACK INK - THIS IS A PEKMANENI KELUKU
25m-(b)-11-49-900,475
M R-302 1
No. Carney Hospital
.
-
(Was deceased a
U. S. War Veteran,
if so specify WAR)
10 SINGLE
(write the word)
1950
have occurred on the date stated above, at
1:55p
.m.
INTERVAL BE-
13 Usual
Occupation:
Chemist
(Kind of work done during most of working life)
Due To
(c)
hypersensitive
cardio vascular disease.
(State or country)
Mass"
4
X
PLACE OF DEATH
(County)
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
P
(City or town making return)
Registered No.
1864
35
2 FULL NAME.
Blanch L. Pigeon
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. .
1.90 Circuit Rd
(Usual place of abode)
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay: In place of death ..
.. years.
months.
11
days. In place of residence
40
years.
.months.
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
March
2,
1950
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
2/19
50
19
to.
3/2
1950
I last saw h ........... alive on
3/2
19 .... 5. Death is said to
have occurred on the date stated above, at
10:52 A
INTERVAL BE- TWEEN ONSET AND DEATH
DISEASE OR CONDITION DIRECTLY LEADING- TO DEATH (a) Multiple embolic
hrs
phenomena with multiple infarctions
ANTE
Due THypertensive arterio
CEDENT (b)
CAUSESs clerotic heart disease
with thrombi in left and right
auri Due$8
(c)
OTHER SIGNIFICANT CONDITIONS arterio sclerosis opr
Major findings:
occluded arterial supply
Of operations.
to right lung
Date of operation
.3 .- 1-50 ....... Was autopsy performed?
yes
What test confirmed diagnosis ?.
autopsy.
5 Was disease or injury in any way related to occupation of deceased?
If so, specify.
R. L. ONeil
M. D.
(Signed)
(Address)
Carne.y ..... Hosp ..... Date ....
3/2/500
6 Winthrop Winthrop.
Place of Burial or Crematfon (City or Town)
DATE OF BURIAL
March ... 4
19 .... 50
21
Informant
Roy W. Pigeon
(Address)
7 NAME OF
FUNERAL DIRECTOR.
Howard Reynolds
ADDRESS
Winthrop
Received and filed
MAR 31 1950
19
(Registrar of City or Town where deceased resided)
PARENTS
18 BIRTHPLACE OF
FATHER (City)
Bangor
(State or country)
Maine
19 MAIDEN NAME
OF MOTHER
Gussie Stubbs
20 BIRTHPLACE OF
MOTHER (City)
Bangor
(State or country)
Maine
25m-(b)-11-49-900,475
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-302 to the clerk of the city or town in which the deceased resided as soon as possible 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 WRITE PLAINLY, WITH UNFAVING BLACK INK - THIS IS A PERMANENI KELUKU
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