USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1953 > Part 34
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15 Social Security No. 029-10-4792
16 BIRTHPLACE (City) Port Saxon (State or country) Nova Scotia
(Kind of work done during most of working life)
64 days
10a If married, widowed, or divorced
HUSBAND of ... Carrie Augusta ..... Smith
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH
(a) Reticulum Cell Sarcoma
13 Usual
Occupation: retired shipper
What test confirmed diagnosis? Biopsy- March 10, 1953
Saprobie ex Dickinson M. D. 20 BIRTHPLACE OF MOTHER (City) Port ..... Saxon
R-301A 1
To be filed for burial permit with Board of Health or its Agent.
PHYSICIAN - IMPORTANT
(Was deceased a
NO.
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-seyen 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.
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 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.
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 rales 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.
No undertaker or other person shall bury or otherwise dispose of a human body (? ? ) , Board of Health physicians will certify to such deaths only as those of in a town, or remove therefrom a human body which has not been buried, until he- 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. 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 bodylany remove it from a town. from one cemetery to another. or from one grave of tomb z:(3) Medical Examiners will investigate and certify to all deaths supposably Ue 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. 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 Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death. 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
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
X .Suffolk (County)
DEVERE
6/3/53
PLACE OF DEATH No. 104 Highland Ave. (Mount!s .Convalescent Home)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No. 113
j (If death occurred in a hospital or institution,
inste
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran. if so specify WAR) Nọ
St. Revere (If nonresident, give city or town and State)
Length of stay: In place of death . years
months 15
In place of residence 55 years
months
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
May (Month
15 (Day)
1953 (Year)
4 I HEREBY CERTIFY.
That I attended deceased!
from
april 24
19 5 3.
to
May 15.
19 53
I last saw h Mamalive on
may
IS, 195 3, death is said to
have occurred on the date stated above. at 6 at 835 P. .m. INTERVAL BE- TWEEN ONSET AND DEATH
10a If married, widowed, or divorced
HUSBAND of
Loretta A.LaPointe
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
7.6 Years
Months
Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation: Retired
(Kind of work done during most of working life)
14 Industry
or Business:
Production Supt. Hersey Co.
15 Social Security No. 022-09-7234
16 BIRTHPLACE (City)
Halifax
(State or country)
Nova Scotia
17 NAME OF FATHER Hi ram Mackinnon
PARENTS
18 BIRTHPLACE OF
FATHER (City) Halifax
(State or country)
Nova Scotia
19 MAIDEN NAME OF MOTHER Anna M.Dunham
20 BIRTHPLACE OF
Date May 16
1953
MOTHER (City)
Halifax
(State or country) Nova Scotia
Place of Burial or Cremation
DATE OF BURIAL May 18, 1953 19
7 NAME OF
michael J. Cancella
ADDRESS . 876 Winthrop Ave.( Revere, Mass
Received and filed
MAY 18 1253
19
(Registrar)
10 yrs
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?
no
(Signed)
Joseph Malismo
M. D.
(Address) 20passant we
6
Woodlawn
Everett
(City or Town)
21 Informant Mrs. Loretta Mackinnon
(Address)
134 Crescent Ave. Revere, Lass.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter Ste faber& (Signature of Agent of Board of Health or other) Trealte Struer 0/15/63
(Official Designation) (Date of Issue of Permit)
JCTIONS OR CERTIFICATE
iving F DEATH t enter han one or each ) and (c)
Does not mean dying, such ure, asthenia. s the disease, tions which
conditions, g rise to the (a) stating ying cause
ons contrib- death but not e disease or using death.
.50M (B)-12-49-900722
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR OR RACE
10 SINGLE
(write the word)
Male White
MARRIED
WIDOWED
or DIVORCED Married
(Give maiden name of wife in full)
DISEASE OR CONDITION
DIRECTLY LEAD
TO DEATH (a)
Cerebral Newarray
4 wks
ANTE CEDENT (b)
Due To Cerebral arterioscleros
CAUSES Denanalyzed arteriosclerosis
R-301A 1 Winthrop (City or Town)
2 FULL NAME George M.C.Mackinnon (If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 134 Crescent. ... Ave. (Usual place of abode)
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 thes 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, cighteen 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 bongdy in a town, or remove therefrom a human body which has not been buried, until ha 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 ceinetery 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 froin 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 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.
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 er 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- Ting 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 dore 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
X Suffolk (County)
(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.
314
Mayflower Nursing Lame
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).
No
St. Ventlup Mas
(If nonresident, give city or town and State)
Length of stay: In place of death years 3 .. months. days. In place of residence 3.0.years .. months .days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
May 18 1953 (Year)
(Month)
(Day)
4 I HEREBY CERTIFY.
That I attended deceased from
august
1952
to
may 18
195-3
I last saw her alive on
Way
17, 1933, death is said to
have occurred on the date stated above, at 3:30 A.m.
DISEASE OR CONDITION DIRECTLY LEADquees of Uterus
TO DEATH (a)
INTERVAL BE- TWEEN ONSET AND DEATH 9 mas.
ANTE Due To CEDENT (b) CAUSES
Due To (c)
OTHER
SIGNIFICANT
CONDITION'S
Major findin
Cancer futures, carcinomatoria
Of operations.
Date of operation
act. 1952
.Was autopsy performed? 200
What test confirmed diagno
Clinical pathological.
5 Was disease or injury in any way related to occupation of deceased? To If so, specify2 .. (Signed) Chealles Liberman M. D. (Address) 238 Chone Drive. WrittenRate. 5/18/19 53
6 Beth Jacob
Place of Burial of Cremation (City_or Town)
DATE OF BURIAL
may 18
1953
7 NAME OF
Paul Rhevine FUNERAL DIRECTOR ...
ADDRESS
470 Haward St. Brookline
Received and filed. MAY 1.8 1953 .19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
FEMALE
9 COLOR QR RACE White
10 SINGLE
MARRIED
(write the word)
widowed
or DIVORCED
10a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Samuel Halfern
(Husband's name in funi)
11 IF STILLBORN, enter that fact here.
12
AGELO 9
Years
Months
Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation :
(Kind of work done during frost of working life)
14 Industry
or Business:
at home
16 BIRTHPLACE (City)
(State or country)
17 NAME OF
FATHER
Samuel Budginsky
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Bussia
19 MAIDEN NAME
OF MOTHER
Soldie Servista
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
21 Informant (Address)
Charles M. Budginaby
137 Comma ave. Rewitone
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of transit permit was issued: Walter & Bakery. (Signature of Agent of Board of Health or other) Health Check 5/18/53
(Official Designation)
(Date of Issue of Permit)
1
R-301A 1
UCTIONS FOR CERTIFICATE
giving OF DEATH t enter than one for each b) and (c)
loes not mean f dying, such ure, asthenia, ns the disease. ations which h.
1 conditions. ng rise to the : (a) stating ying cause
ions contrib- death but not e disease or using death.
50M-2-19-25666
2 FULL NAME ..
No. Deborah
Sudanshy Halpern
(a) Residence. No. (Usual place of abode)
(If deceased is a married, widowed or divorced woman, give also maiden name.) 150 Shore Duve
Registered No.
House- Wife
15 Social Security No.
Quasia
PARENTS
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
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