USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1954 > Part 30
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DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER .....
M R-305 1
PLACE OF DEATH
SUFFOLK (CountySTON
(City or Town)
No. Hotel Kenmore
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
(City or town making return)
Registered No.
:3386 ..
89
(If death occurred in a hospital or institution. Į give its NAME instead of street and number)
2 FULL NAME (If deceased is a married, widowed of
MORTON .M ..... SCOPP
woman, give also maiden name.)
15 .... Townsend 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. ... years. months. ... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STA'Isi:CAL PARTICULARS
9 SEX
M
10 COLOR OR RACE
11 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
11a If married, widowed, or divorced
HUSBAND of
Josephine .... E ... Mattev
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
13
1
AGE07
8
Years
Months
.Days
If under 24 hours
Hours ....
.Minutes
14 Usual
Occupation :
(Kind of work done during most of working life)
15 Industry
or Business:
Chemicals
16 Social Security No.
014-12-0224
17 BIRTHPLACE (City)
(State or country)
Uxbridge, Mass
18 NAME OF
FATHER
Walter P Scott
19 BIRTHPLACE OF
FATHER (City)
(State or country)
Uxbridge, Mass
20 MAIDEN NAME
OF MOTHER
Sarah E Mowry
21 BIRTHPLACE OF
MOTHER (City)
Uxbridge, Mass
(State or country)
J Scott
DATE OF BURIAL 19
54
8 NAME OF
FUNERAL DIRECTOR
"HReynolds
ADDRESS.
Received and filed
Winthrop, Mass .19
(Registrar of City or Town where deceased resided)
V.13 V
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-(c)-11-49-900.475
7
Place of Burial, or Cremation. (City or Town)
22
Informant
(Address)
A TRUE COPY. Markes H. Mackie
ATTEST:
(Registrar of City or Town where death occurred) Apr 21
54
DATE FILED
.19
2,5,
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
(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? ........ no
6 Was disease or injury in any way related to occupation of deceased ?. If so, specify.
(Signed)
"Luongo
M. D.
(Address) Bo.s.toR.
Date.
Winthrop
.......... 19
Winthrop
PARENTS
4
Manufacturer
5 Accident, suicide, or homicide (specify)
Date and hour of injury
19
Where did
Injury occur?
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.) Coronary occlusion
3 DATE OF
DEATH
1954
S
(Was deceased a
U. S. War Veteran,
( if so specify WAR)
(a) Residence. No. (Usual place of abode)
Apr 19
6
MAY-8
4
5/1/5
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.
30
J(If death occurred in a hospital or institution. St. [ give its NAME instead of street and number)
angelo Ottone
(If deceased is a married, we'dowed or divorced woman, give also maiden name.)
(a) Residence. (Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death years ... months /0 days. In place of residence.
.years months .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
April
(Month)
(Day)
(Year)
8 SEX
male
9 COLOR OR RACE
10 SINGLE
MARRIED
(write the word)
or DIVORCED
4 I HEREBY CERTIFY,
That I attended deceased from
Sept
1947
to
April is
وجود
I last saw h ( ??? alive on 17 pril 18, 19 57, death is said to
have occurred on the date stated above, at 10 0pm
INTERVAL BE-
TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12 68
Months
Days
If under 24 hours
.Hours .. ... Minutes
13 Usual
Occupation
Lalover (Retired)
14 Industry
or Business:
Construction Work
15 Social Security No.
16 BIRTHPLACE (City). (State or country)
Italy
17 NAME OF
FATHER
not aloned'
Major findings:
Of operations
Ca of Colon- Blain 1941-53
147 - 53
Date of operation. .Was autopsy performed? What test confirmed diagnosis? Lab test (Path)
5 Was disease or injury in any way related to occupation of deceased? na If so, specify. (Signed)
John C. Corrado M. D. (Address) 122 Jara Fega St Date 4-70 195 74
St. Michael
(City or Town)
DATE OF BURIAL avril 21
1955
7 NAME OF FUNERAL DIRECTON
alli Ceitox a
ADDRESSING
Received and filed. APR 2 0 1954
19
(Registrar)
1947
ANTE
Due To,
with Metastasis To
CEDENT (b).
CAUSES
Lung and Brain
Due To (c)
OTHER SIGNIFICANT CONDITIONS
PARENTS
20 BIRTHPLACE OF MOTHER (City) (State or country)
21 Informant Tyre Idy Clemente
I HEREBY CERTIFY that a satisfactory standard certincate of death was filed with me BEFORE the burial or transit permit was issued: Walter A: Bakery. Signature of Agent of Board of Herlin or other)
Healthe Officer 4.20.54
(Official Designation)
(Date of Issue of Permit)
X
RUCTIONS FOR L CERTIFICATE giving CF DEATH not enter than one for each (b) and (c)
does not mean of dying, such ilure, asthenia, ans the disease. ications which ath.
bid conditions, ving rise to the se (a) stating erlying cause
itions contrib- he death but not the disease or causing death.
50M-5-52-907046
PLACE OF DEATH
Suffice County) Winthrop (City or Town)
KOSTEN
Bayview Hering Home 4 Workington Que
2 FULL NAME
440 Saratoga
St.
East
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, no if specify WAR).
10a If married, widowed bor divora
Gutenuit Barbera
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
DISEASE OR CONDITION DIRECTLY LEADING TO DEATH (a) descending colon
CARaudioma of
(Kind of work done during most of working life)
1 years
18 BIRTHPLACE OF FATHER (City) (State or country)
Italy
19 MAIDEN NAME OF MOTHER not Learned
6 Place of Burial @ Cremation
54
Registered No.
M R-301A 1
0-2-1326
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 hy 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 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 hodies 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 hody 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 s traumatism (including resulting septicemia), and by the action of chemical ·(drágs 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
PLACE OF DEATH
X Luital ... (County) A Winters (City or Town)
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.
91
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number) No.
2 FULL NAME. George
A Weeksen Sr.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 49 Johnson Ave Winthrop (Usual place of abode)
St.
(If nonresident, give city or town and State)
Length of stay: In place of death. years. T months. days. In place of residence 30.years months .. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
april
18
1954
(Year)
8 SEX
male
9 COLOR OR RACE
white
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED married
4 I HEREBY CERTIFY,
That I attended deceased from
april 2
54
to
april 18
19
1g ,54
I last saw
beinalive on
agent (), 1954, death is said to
have occurred on the date stated above, at.
9:10 Am.
INTERVAL BE- TWEEN ONSET AND DEATH 2 year
11 IF STILLBORN, enter that fact here.
12
AGE 6.8.
Years
3
Months
2.1 Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation:
Schoolteacher (Retired)
(Kind of work done during most of working life)
14 Industry
or Business:
Cambridge Public Schools
15 Social Security No ...
none
16 BIRTHPLACE (City)
(State or country)
Mass
17 NAME OF
FATHER
John T. Wickson
18 BIRTHPLACE OF
FATHER (City) (State or country) England
19 MAIDEN NAME
OF MOTHER
Emma Hiltz
20 BIRTHPLACE OF MOTHER (City) (State or country) England
Mrs. Elizabeth C. Wickson
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
after t- Hapert-
(Signature of Agent of Board of Health or other) Flatt e rifle t. 4.26.54
(Official Designation)
(Date of Issue of Permit)
1.13
UCTIONS FOR CERTIFICATE
giving OF DEATH
ot enter than one for each b) and (c)
does not mean of dying, such lure, asthenia, ns the disease, ations which h.
d conditions, ing rise to the e (a) stating lying cause
ions contrib- death but not he disease or ausing death.
50M-5-52-907046
7 NAME OF
FUNERAL DIRECTOR
Richard .... C ....... Kirby
ADDRESS
917 Bennington St E .Boston
Received and filed.
30 1954 19
(Registrar)
2 years
Due To (c)
OTHER
Agpertencem
SIGNIFICANT
CONDITIONS Residual Cerebral Her?
9 mos
Major findings:
Of operations
hone recently
Date of operation
What test confirmed diagnosis?
.. Was autopsy performed?
Electrocardiogram
no
5 Was disease or injury in any way related to occupation of deceased?
If so, specify [+ ] Gelir
(Signed)
M. D.
(Address) Menu mars Date 8 ajul
190 ×
6
Winthrop
Winthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL April 21 19.5.4
PARENTS
10a If married, widowed, or divorced
HUSBAND of.
Elizabeth Covelle Foulkes
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Coronary
Selensis
ANTE
CEDENT
(b)
Due To
Generalized
CAUSES
(Month)
(Day)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
Registered No.
Wencheop Community Resp
[ R-301A 1
15.
21 Informant (Address) 49 Johnson Ave Winthrop
Charlestown
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death. . . Gen. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death as required by the preceding section or by section forty-five of chapter one hundred and four- teen, shall, if the deceased, to the best of his knowledge and belief, served in the army, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that effect, specifying the war, and shall also certify in such certificate both the primary and the secondary or imme- diate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer, shall forfeit ten dollars. For the purposes of this section and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied. in case of an original inter- ment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the
death certificate contains a recital, as required by, section ten of chapter forty-six. that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registra- tion. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of persons as are supposed to have died by violence, or by the action of chemical, thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead. .. - General Laws, Chap. 38, 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 qr 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.
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