USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1952 > Part 53
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The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Bos ton
(City or town making return)
153 6456
Registered No.
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.) 104 Highland Ave.
St.
(If nonresident, give city or town and State)
Length of stay: In place of death.
.. years.
months. 7 days. In place of residence
7
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,
July 8
52
July 15
19
I last saw h
alive on
19
death is said to
11;15AM
INTERVAL BE-
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
embolism
TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
AGE
Months
Days
If under 24 hours
Hours ...
.. Minutes
ANTE
Due To
Fracture left hip .
CEDENT (b)
CAUSES
pt.fell at home
7 Days
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
Date of operation.
Was autopsy performed?
What test confirmed diagnosis?
Clinical
PARENTS
18 BIRTHPLACE OF
FATHER (City)
Prince Edward Island
(State or country)
19 MAIDEN NAME
OF MOTHER
Elizabeth Dingwell
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Prince Edward Island
Woodlawn Cem-Everett Mass.
6
Place of Burial or Cremation (City or Town)
DATE OF BURIAL
July 18/52
19
21
Informant
(Address)
L M Hunter
A TRUE COPY es A. LMache
ATTEST:
(Registrar of City or Town where death occurred) July 21/52
DATE FILED
.....
.19
of death should be transmitted on Form R-302 to the clerk of the city of town in which the deceased resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46. Sec. 12, G. L.)
25M.(B) 11-51-905807
+
PLACE OF DEATH
Suffolk (County)
No.
(Suzzanne)
2 FULL NAME
Susannah Perkins Coffin
(Was deceased a
U. S. War Veteran,
if so specify WAR)
Winthrop Mass.
(a) Residence. No. (Usual place of abode)
July 15/52
3 DATE OF
DEATH
(Month) (Day)
(Year)
That
I
attended deceased from
52
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
13 Usual
Occupation:
Housekeeper
(Kind of work done during most of working life)
14 Industry
or Business:
Private Home
15 Social Security No.
None
16 BIRTHPLACE (City)
(State or country)
Prince Edward Island
17 NAME OF
FATHER
William Coffin
5 Was disease or injury in any way related to occupation of deceased ?.
If so, specify.
M W O' Connell
M. D.
(Address)
Boston City HospHate
19 ..
7 NAME OF
FUNERAL DIRECTOR
Winthrop Mass ..
ADDRESS
H S Reynolds
Received and filed
tvq. 1, 1952
19
(Registrar of City or Town where deceased resided)
96 Hrs12
81
Years
8
15
(Signed)
19
to
have occurred on the date stated above, at
Cerebro vascular
RECEIVES
١٠
NI.
2
6
AUG-
+
PLACE OF DEATH
(County) Throp -.
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burlal pormit with Board of Health or its Agent.
154.
(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME.
(H deceased is a married, widowed ondivorced woman, give also maiden name.)
110 Z
(a) Residenoe. No. (Usual place of abode)
(If nonresident, give city of town and State)
Length of stay: In place of death ............ years. months ............ days. In place of residence.
16
.. years
months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF DEATH
(Month) (Day)
15
1952
(Year)
9 SEX
Male
10 COLOR OR RACE
White
11 SINGLE
MARRIED
WIDOWED
of DIVORBEIngle
11a If married, widowed, or divorced
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 ... 16 Years.
1Months.
IDays
If under 24 hours
Hours
Minutes
14 Usual
Occupation:
Student
(Kind of work done during most of working life)
15 Industry
or Business :.
School
16 Social Security No.
Winthrop
17 BIRTHPLACE (City).
(State or country)
Mass
-
18 NAME OF
FATHER
Carl Hoffman
19 BIRTHPLACE OF
FATHER (City)
Minthron
(State or country)
Mass
20 MAIDEN NAME
OF MOTHER
Helen J.Rowan
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
22
Informant.
Carl
Hoffman
(Address)
190
Lincoln St
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter S. Bakery.
(Signature of Agent of Board of Health or other)
Healthy Officer 7/17/52
(Official Designation)
(Date of Issue of Permit)
(Registrar)
PARENTS
Was disease or injury in any way related to occupation of deceased ?.
If so, specify
...
(Signed)
M. D.
(Address) 35 Shattuck Date 7/1
.. 19,5.
7 Mt. Wollaston
Quincy ..... Mass.
Place of Burial, or Cremation.
(City or Town)
DATE OF BURIAL
July 18
1952
8 NAME OF
FUNERAL DIRECTOR
John F. Omaley
ADDRESS
KAthron Mass
Received and filed
JUL 17 1952
19
25M (A)-8-50-902 592
of Death. See reverse side for extracts from the laws relative to the return of certificates of death. DEATH in plain terms, so that it may be properly classified under the International Classification of Causes If deceased was a U. S. War Veteran, G.L. Chap. 46, Section 10. requires physicians to insert a recital to that effect.
5 Accident, suicide, or homicide (specify) ..
anidet
Date and hour of injury ..
15 1952
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? Short Beach
(Specify type of place)
Manner of
Injury
(How did injury occur?)
Nature of
Injury
While at work?
Was autopsy performed? .......
R-303 A
(City or Town) Waters of Short Beach
Registered No.
John.
Hoffman
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran. if so specify WAR)
(write the word)
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.) due to
X
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. as amended by Chap. 48, Acts of 1927 and Chap. 414, Acts of 1931.
No undertaker or other person 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., as amended.
Medical examiners shall make examination upon the view of the dead bodies of persons as are supposed to have died by violence, or by the action of chemical, thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead ......- General Laws, Chap. 38, Sec. 6., as amended by Chap. 632, Sec. 4, Acts of 1945.
The medical examiner certifies the cause and manner of death to the best of his knowledge and belief.
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 mijaty: "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
Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify: (1) Under cause the nature of an injury and of its consequences; and (2) under manner the mode of its production together with the circumstances when these are known. For example: "Compound fracture of the femur with ensuing septicemia (gas bacillus) caused by a steam railway accident.""Pistol shot wound of the chest with associated hemorrhage, hom- icidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether administered as a surgical anaesthetic." "Fracture of the skull with associated internal injury sustained under circumstances unknown."
If disease or injury was related to occupation, specify. If investigation shows the death to have been due to disease, specify: (1)Under cause its known or presumable nature; and (2) under manner, indicate the circumstances leading to medico-legal inquiry. For example: "Hemorrhage spontaneous of the brain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)''
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. 155
Registered No.
[(If death occurred in a hospital or institution. St. Į give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(Was deceased a
S. War Veteran.
Winthrop 32, Mass.
(If nonresident, gi city or town and State)
Length of stay: In place of death years months days. In place of residence 35.years
.months .. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF DEATH
July
(Month) 1 (Day)
1952 Year)
4 I HEREBY CERTIFY, July 1
19
45 to July 17
19
death is said to
have occurred on the date stated above. at
INTERVAL BE- TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
1 day 12 8988
AGE
Years
Months
.. 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)
England
Hlinud
17 NAME OF
FATHER
Unable to obtain
18 BIRTHPLACE OF
FATHER (City)
(State or country) England .
Unable to obtain
Date of operation.
Was autopsy performed ?..
What t Clinical + laboratory
8:00 5 Was disease or injury in any way related tooccupation of deceased? If so, speci facile & aliquo M.W (Signed) 562 Stanley / Date 7/17/50m
6 Winthrop~ Wwwup 32 Mais Place of Burial or Cremation (City Winthrop
DATE OF BURIAL July 19 52
7 NAME OF
FUNERA
Lowand S Cheynolds
ADDRESS
Received and filed
JUL .18.1952
19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Femalel
9 COLOR OR RACE
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Wido
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Alfred Illingworth
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION DIRECTLY LEAD Acute Coronary TO DEATH (a)
ANTE CEDENT CAUSES
Due
Ortenosclastic
Leaux aliseare
Due To (c) .. arteriosclerosis
OTHER SIGNIFICANT CONDITIONS
Perulity
1 3r.
PARENTS
19 MAIDEN NAME OF MOTHER Unable to obtain
20 BIRTHPLACE OF MOTHER (City) (State or country) England
21 Percy Illingworth
Informant
(Address)
193 Main St. Winthrop, 18
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Wollte I. alerg.
"(Signature of Agent of Board of Health or other)
Health Quele
her/18/52
(Official Designation)
(Date of Issue of Permit)
,
NS FICATE
EATH er one ich d (c)
t mean g. such thenia, disease. which EROTIC itions. to the stating cause
ontrib- but not ase or death.
100M.(D)-10-45-24658
01A 1
No.
193 Main St.
martha anne Aling worth
2 FULL NAME
(a) Residence. No. (Usual place of abode)
(If deceased is a married, widowed or divorced woman, give Also maiden name.) 193 Main St
That
attended
deceased from
I last saw a alive on .... 7A.M
2yrs
4 yrs
Bradford
Major findings:
Of operations
Y M. D. (Address)
Unable to obtain
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 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 que 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.
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