USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1953 > Part 63
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SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT
SERVICE NUMBER
-
Y PLACE OF DEATH
12/5/53
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
Registered No. 202.
Mayflower Rest Home j(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME.
Pierce R. Smith
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. (Usual place of abode)
Leslie Road
St.
Ipswich.
.Mass
(If nonresident, give city or town and State)
Length of stay: In place of death
.years.
1
months.
days. In place of residence
5
.years
.months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
White
9 COLOR OR RACE
10 SINGLE
(write the word)
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
Nav.1. 1952.
to .....
Sept 14
19 5.3
I last saw h wy alive on
Sept. 14, 1953, death is said to
5:00 A.m.
have occurred on the date stated above, at
INTERVAL BE-
TWEEN ONSET
DISEASE OR CONDITION
Signvoid.
DIRECTLY LEADING
TO DEATH (a)
Cancer of Sigmoid
AND DEATH
18 muss
11 IF STILLBORN, enter that fact here.
12
AGE
60 Years
Months
Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation :
Painter
(Kind of work done during most of working life)
14 Industry
or Business:
Automobile Painter
15 Social Security No.
16 BIRTHPLACE (City).
(State or country)
Mass
17 NAME OF
FATHER
George Smith
18 BIRTHPLACE OF
Was autopsy performed ?.
200.
FATHER (City)
Boston
(State or country)
Mass
19 MAIDEN NAME
OF MOTHER
Annie Ireland
20 BIRTHPLACE OF
Cambridge
MOTHER (City)
(State or country)
Masg
21 Minnie Ireland
Informant.
(Address)
30 Myrtle Ave Winthrop
Walter I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Batter.
(Signature of Age Cof Board of Health or other)
Ito.
9/14/53.
(Official Designation)
(Date of Issue of Permit)
ICTIONS OR ERTIFICATE
iving F DEATH t enter han one or each ) and (c)
Des not mean dying, such re, asthenia, s the disease. tions which
conditions. g rise to the (a) stating ving cause
ons contrib- eath but not disease or using death.
50M-10-52-908091
7 NAME OF
FUNERAL DIRECTOR
John F. O Maley
ADDRESS
Winthrop Mass.
Received and filed
SEP 18 1953 19
(Registrar)
PARENTS
5 Was disease or injury in any way related to occupation of deceased 200
It so,
(Signed)
(Address) 238 Phone Value
Date 9/14/1953
6
Mt .. . Wollaston
Place of Burial or Cremation
(City or Town)
Quincy Mass
DATE OF BURIAL
September 16,
1953
Major findings:
Of operations.
Cancer
Date of operat
Kan. 1952
What test confirmed diagn
Clinical + pattiological
Boston
OTHER
SIGNIFICANT
CONDITIONS
none
ANTE
Due To
more
CEDENT (b)
CAUSES
Due To
(c)
10a If married, widowed, or divorced
HUSBAND of .. Marion Sullivan Smith
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
3 DATE OF
DEATH
September 14,
1953
No.
Suffolk (County)
R-301A 1
Winthrop (City of Town)
To be filed for burial ·permit with Board of Health or its Agent.
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, ( if so specify WAR)
MARRIED
WIDOWED
or DIVORCEDOwed
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, speeifying 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 inelude the China relief expedition and the Philippine insurrection, which shall. for said purposes, be decmed 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 hoard 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 sueh 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, hy 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 hy violence, the medical examiner shall make such certificate. If such a permit for the removal of a human hody, 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 he 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, 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 derk of the town where the body is to be buried or the funeral is to he held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made.
Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the follow- ing rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deathsonly as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very import- ant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestie 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
Essex
(County) Danvers
(City or Town) Danvers State Hospital,
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH Hathorne
Danvers
(City or town making return)
Registered No. 203
f(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
No. Nesaniel Kind
2 FULL NAME.
(If deceased ina martie), widowed prodivorced woman, give also maiden name.)
St.
(If nonresident, give city or town and State)
Length of stay: In place of death .years
days. In place of residence. .......... years ..
months.
... days.
ICAL CERTIFICATE OF DEATH 953
3 DATE OF
DEATH
(Month) (Day)
(Year)
4 I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.) Arteriosclerotic heart disease
11a If married, widowed, or divorced
HUSBAND of
Sarah m.n. unknown
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
13
AGE 57 Years 5
Months
6 Days
If under 24 hours
Hours .....
Minutes
14 Usual
Occupation:
Dress Salesman
(Kind of work done during most of working life)
15 Industry
or Business:
16 Social Security No.
17 BIRTHPLACE (City)
(State or country)
Russia
18 NAME OF
FATHER
Joshua Kind
19 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
20 MAIDEN NAME
OF MOTHER
Cannot be learned
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
22
Informant
y F.Shechan
(Address)
Hathorne
A TRUE COPY.
ATTEST:
(Registrar of City or Town where death occurred)
September
21,
53
DATE FILED
(Registrar of City or Town where deceased resided)
53
DATE OF BURIAL
Scholosaberg &-
Sen
.19
8 NAME OF
FUNERAL DIRECTOR
"Dorchester, Mass:
ADDRESS
Received and filed OCT. 7. 1953 19
...
9. SEX e
10 COLORIOB RACE
11 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write. the moded
5 Accident, suicide, or homicide (specify)
Date and hour of injury.
19
Where did
Injury occur?
(City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in public
place?
(Specify type of place)
Manner of
Injury
(How did injury occur?)
Nature of
Injury
While at work?
.Was autopsy performed?
6 Was disease or injury in any way related to occupation of deceased?
If so, sp
Ralph P. cCarthy
(Signed)
Peabody, Mass.
9. 16. м. БВ
(Address). 4: With Peoplest Cer.
PARENTS
25m-(c)-11-49-900.475
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 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 after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
14.5
PLACE OF DEATH
M R-305 1
(a) Residence. No. (Usual place of abode) 2 2
months 27
PERSONAL AND STATISTICAL PARTICULARS
(Was deceased a Unt. WarMergran, If so specify WAR)
19
VEV
7 Place of Burial, or Cremation. September (City of Town)
RECEIVE
TOR
THROP.
OCT-2 PH
x
PLACE OF DEATH
Suffolk (County)
I R-301 1 Winthrop
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
(City or town making return)
STANDARD CERTIFICATE OF DEATH
Registered No.
204
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.)
(a) Residence. No. (Usual place of abode)
133 So jerget Ave.
St.
(If nonresident, give city or town and State)
Length of stay: In place of death ..
.years ....
months 1 days. In place of residence 2.) yes
.. months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR OR RACE
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED Harried
4 I HEREBY CERTIFY,
deceased from
October
1952
to
That I attended
Sept.
1953
10a If married, widowed, or divorced
HUSBAND of.
Harion
Cole
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADINGO
TO DEATH (a)
Cerebral Thrombosis
(recurrent)
ANTE
Due To generalized
CEDENT (b)
CAUSES
arteriosclerosis
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
Date of operation
Was autopsy performed? no
What test confirmed diagnosis ?.
clinical
5 Was disease or injury in any way related to occupation of deceased' no
M. D. (Signed) (Address) Winthrop Date 18 Sept 1953
Winthrop/
Place of Burial or Cremation
(City or Town) Sept. 21 19.53
DATE OF BURIAL
7 NAME OF
FUNERAL DIRECTOR
Howard Solynolds
ADDRESS
Winthrop mures
Received and filed SEP 21 1953 19
(Registrar)
A TRUE COPY ATTEST:
INTERVAL BE- TWEEN OHSET AND DEATH 5 days
11 IF STILLBORN, enter that fact here.
5,5
12
AGE
Years
6
Months.
20
Days
If under 24 hours
Hours ... ... Minutes
13 Usual
Occupation:
Mainter@ice
(Kind of work done during most of working life)
14 Industry
or Business:
Teleilmio Co.
15 Social Security No ....
011-05-0672
16 BIRTHPLACE (City) ....
(State or country)
17 NAME OF
FATHER
Daniel W Hall
18 BIRTHPLACE OF
FATHER (City)
Auburn
(State or country) I.ew Hampshire
19 MAIDEN NAME
OF MOTHER
Fannie Hazlett
20 BIRTHPLACE OF
MOTHER (City)
Glascow
(State or country) Scotland
21 Marion Hall
(Address)
Informant 733 Somerset Ave. Pintaron
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial on transit permit was issued: Walter &. Hakers. (Signature of Agent of Board of Health or other) Health Officer 9,21.53
(Official Designation)
(Date of Issue of Permit)
ACTIONS OR CERTIFICATE giving OF DEATH t enter han one for each b) and (c)
loes not mean dying, such ure, asthenia, > s the disease, ations which
id conditions, g rise to the (a) stating ying cause
tions contrib- death but not re disease or using death.
250M -(A) -11-51-905807
M.S.
No.
Winthrop Community Hospital
Clifford Webster Hall
3 DATE OF
DEATH
Lekt.
18
1953
(Year)
(Month)
(Day)
I last saw h .. c/m. alive on ...
18 Sept
195.w ... , death is said to
(Give maiden name of wife in full)
have occurred on the date stated above, at. 7:17 A.m.
100 years
PARENTS
6 winthrop
(Was deceased a
U. S. War Veteran,
if so specify WAR)
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 tbe 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 hest of his knowledge and helief 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 hy the physician or officer and the date of his death. . . Gen. Laws, Chap. 46, Sec. 9.
-
A physician or officer furnishing a certificate of deatb as required by the. preceding section or hy section forty-five of chapter one hundred and four- l. J 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 heen; 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 tbe. Cbina relief expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place hetween February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen bundred and sixteen and nineteen hundred and seven- teen. G. L. Cbap. 46, Sec. 10.
No undertaker or other person shall hury or otherwise dispose of a human body in a town, or remove therefrom a human body which bas not been buried, until he has received a permit from the hoard 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 hody SER remove it from a town, from one cemetery to another, or from one grave of 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 he issued until tbere shall have heen 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 he 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 hy the selectmen for the purpose, sball upon application make the certificate required of the attending physician. If death is caused hy 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 he obtained early enough for the purpose, the certificate of death made as ahove provided and in tbe possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such hody shall he 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 hody has heen 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 heen engaged, such recital shall appear upon the permit. The hoard 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 registration. 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 he obtained as to the deceased, or as to the manner or cause of the deatb, 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 bave died hy violence. If a medical examiner has notice that there is within his county the hody of such a person, he shall forthwith go. to the place where the hody lies and take charge of the same; : . General Laws, Chap. 38, Sec. 6.
No undertaker or other persons sball hury a human body or the asbes thereof , which have been brought into the commonwealth until he has received a permit so' to do from the hoard of health or its agent appointed to issue such permits, or if there is no such hoard, from the clerk of the town where the body is to be buried or the funeral is to he held, or from a person appointed to have the care of the cemetery or hurial 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 following rules of practice :
·'(1) Attending physicians will certify to such deaths only as those of persons to whom they have given hedside care during a last illness from disease unrelated to any form of injury.
!? [](2) Board of Health physicians will certify to such deatbs 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 occupa- tion, the sudden deaths of persons not disahled hy 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 heen given up or changed, or if the deceased had retired from husiness, report the kind of work done during most of working life even if retired. Children not gainfully employed may he 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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