USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1955 > Part 4
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SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE 8/14/18
DATE OF DISCHARGE
12/4/48
RANK, RATING Corporal
ORGANIZATION AND/OUTFIT
SERVICE NUMBER 4187716
M R-302 1
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
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, Ser 12, G. L.) of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible
PLACE OF DEATH
Essex (County) Haverhill (City or Town) Hale Hospital No.
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
(City or town making return)
8
Registered No.
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
Joseph Lewis
(If deceased is a married, widowed or divorced woman, give also maiden name.)
Point Shirley 24h Grand Ving these.
Winthrop
(If nonresident, give city or town and State)
Length of stay: In place of death.
.years.
1
.months.
days. In place of residence ..
.years.
months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
January
13
1955
(Month)
(Day)
(Year)
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED idowed
AI HEREBY CERTIFY.
Dec. 19
54
19
to
Jan. 13
19
55
I last saw h
alive on
im
Jan. 13
,55
19
death is said to
have occurred on the date stated above, at
m.
INTERVAL BE- TWEEN ONSET AND DEATH 48 hr
11 IF STILLBORN, enter that fact here.
12
AGE .. 7.6 .. Years. 10 Months2 ~
If under 24 hours
Hours.
Minutes
Acute thrombocytopeniary
ANTE
Due Iq
purpura
CEDENT (b) thrombosis-Cerebral.
CAUSES
thrombosis Pulmonary
Due To
Old Rheumatic
(c)
heart disease
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
No.
Date of operation
Was autopsy performed?
What test confirmed diagnosis ?.
No
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
N.B.Miller
(Signed)
Haverhill
3/14 M5B 19.
6
Place of Burial or Cremation
(City or Town) 1955
DATE OF BURIAL
January 15
21
Informant
(Address)
Emma Nichols
Haverhill
A TRUE COPY
ATTEST:
(Registra .. .....
DATE FILED
Jan. 18
19
55
(Registrar of City or Town where deceased resided)
PARENTS
17 NAME OF
FATHER
Daniel
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Conn.
19 MAIDEN NAME
OF MOTHER
Ida Smith
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Conn.
7 NAME OF
FUNERAL DIRECTOR
Earle W. Graffam
Haverhill
ADDRESS
Received and filed.
FEB - 9 1955
55
10a If married, widowed, or divorced
HUSBAND of
Flora ... B ....
Nichols
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Uremia
13 Usual
Occupation :
Real Estate Operator
(Kind of work done during most of working life)
14 Industry
or Business:
15 Social Security No
012-20-9510
16 BIRTHPLACE (City)
(State or country)
Conn.
New London
(Address) oad Gem
Date ..
HaverhiIT
25M (E).6-50-902253
2 FULL NAME
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No. (Usual place of abode)
3 P.
That I attended deceased
from
(write the word)
VRV
RECEIVED
TOW
OF
11.12 1
OFFICE
1
5
6
THROP
FEB-9
M R-301A
X Suffolk (County) Winthrop (City or Town) 236 MAin No. PLACE OF DEATH Joseph J. McLean 2 FULL NAME
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.
9
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.)
(a) Residence. No. 236 MAIN (Usual place of abode)
St.
(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
3 DATE OF
DEATH
Janu
(Month)
(Day)
January
13
1955
(Year)
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
HARRied
4 I HEREBY CERTIFY.
That I attended deceased from
19 to
19
10a If married, widowed, or divorced Smith HUSBAND of ETner (Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
66
Years
Months.
Days
If under 24 hours
.Hours
Minutes
13 Usual
Occupation:
Steamship
Agent
(Kind of work done during most of working life)
14 Industry
or Business:
Retired
15 Social Security No ....
022-26-7173
EAST Boston
16 BIRTHPLACE (City)
(State or country)
MASS
17 NAME OF FATHER Daniel McLean
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Nova Scotia
19 MAIDEN NAME
OF MOTHER
Catherine Beaton
20 BIRTHPLACE OF MOTHER (City) (State or country)
Nova Scotia
21
Informant
Ethel I McLean
(Address) 236 MAIN ST. WinthRED
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit perout was issued:
Walter 2. Kakurz. (Signature of Agent of Board of Health or Other)
Health Office 1/14/55
(Official Designation)
(Date of Issue of Permit
50M-5-52-907046
DATE OF BURIAL ..
JAN
15
7 NAME OF
FUNERAL
ADDRESS
FAST Boston
Received and filed 1-17-55 19
(Registrar)
INTERVAL BE- TWEEN ONSET AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Natural Causes
ANTE
CEDENT (b)
CAUSES
Due To Presumably
Due To
Coronary
(c)
Occlusion
OTHER SIGNIFICANT CONDITIONS
Major findings:
Of operations
Date of operation
Was autopsy performed ?. no
What test confirmed diagnosis ?.
Health 1 M. D. 5 Was disease or injury in any way related to occupation of deceased? no ft s (Sig (Address) Manthrop Board of 11 Date 13 Jamie 55
6 Winthrop
Winthrop
Place of Burial of Cremation (City or Town)
1955
PERSONAL AND STATISTICAL PARTICULARS
15.
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR)
None
TRUCTIONS FOR IL CERTIFICATE
n giving OF DEATH not enter e than one e for each , (b) and (c)
s does not mean e of dying, such failure, asthenia, eans the disease. lications which eath.
bid conditions, iving rise to the use (a) stating derlying cause
ditions contrib- the death but not o the disease or causing death.
M.S.
Registered No.
PARENTS
I last saw h .............. alive on
19 ........ , death is said to
have occurred on the date stated above, at.
8 A.
m.
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 broughtinto the commonwealth until he has received a permit so to do from the board of Health droits 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 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).
·
11.12 RULES OF PRACTICE r
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 médical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons). thermal or electrical agents, and deaths following abortion. but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very import- ant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
+
PLACE OF DEATH
Suffolk (County)
M R-301 1 Winthrop
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
(City or town making return)
Registered No. 10
J(If death occurred in a hospital or institution,
St. \ give its NAME instead of street and number)
Elizabeth E (Fullerton) Simson 2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
80 Somerset Ave.
St.
(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 STATISTICAL PARTICULARS
3 DATE OF
DEATH
JAN
(Month)
(Day)
14
1955
(Year)
8 SEX
Female
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED IdOW
1
4 I HEREBY CERTIFY,
That I attended deceased from
SEPT
52
to
JAN 14
19
I last saw h. ER JAN 13 1055 death is said to
4 45 A
m.
INTERVAL BE-
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of
John W Simson
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
Years
1
Months.
Days
If under 24 hours
Hours
.Minutes
13 Usual
Housewife
Occupation:
(Kind of work done during most of working life)
14 Industry
or Business:
Own Home
15 Social Security No.
None
16 BIRTHPLACE (City)
(State or country)
Nova Scotia
17 NAME OF
FATHER
Alexander Fullerton
PARENTS
18 BIRTHPLACE OF Advocate
FATHER (City)
(State or country)
Nova Scotia
19 MAIDEN NAME
OF MOTHER
Linda Alen
20 BIRTHPLACE OF
MOTHER (City)
Advocate
(State or country)
Nova Scotia
Phyllis Brooks
21
Informant *..
(Address)
80 Somerset Ave. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter S. Kalle (Signature of Agent of Board of Health of other)
Health Officer
1/14/25
(Official Designation)
(Date of Issue of Permits 110
RUCTIONS FOR L CERTIFICATE
giving OF DEATH not enter than one for each (b) and (c)
does not mean of dying, such ilure, asthenia, ans the disease, ications which ath.
id conditions. ring rise to the se (a) stating rlying cause
itions contrib- e death but not the disease or causing death.
50M (A)-1-51 903586
DATE OF BURIAL
Jan.
17
19.55
7 NAME OF
FUNERAL DIRECTOR
Howard S Reynolds
ADDRESS Winthrop mais.
-17-55
19
Received and filed.
(Registrar)
A TRUE COPY ATTEST:
TWEEN ONSET AND DEATH 3 DAYS.
ANTE
Due To ARTERIOSCLERITIC
3 YRS.
Due TO WITH CONGESTIVE
(c)
HEART FAILURE
OTHER
SIGNIFICANT
GLAUCOMA
16 YRS
CONDITIONS
Major findings:
Of operations.
NONE
Date of operation.
Was autopsy performed?
What test confirmed diagnosis ?.
ELECTRO CARDIOGRAM.
5 Was disease or injury in any way related to occupation of deceased? NO
If so, specify
(Signed)
myron n. Kung
M. D.
(Address) 212 PLEASANT ST. WINTHERBate JAN IY 1955
6
Winthrop
Place of Burial or Cremation
(City or Town)
Winthrop
No.
(City or Town) Winthrop Community Hospital
CERTIFICATE OF DEATH
(a) Residence. No. (Usual place of abode)
3
35
(Was deceased a
U. S. War Veteran,
[if so specify WAR)
(write the word)
19
55
have occurred on the date stated above, at
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
POSTERIOR MYOCARDIAL
INFARCT.
CEDENT (b)
CAUSES
HEART DISEASE
77 0
Grand Pre
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital inedical 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 len of chapter fortv-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 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.
RECEIVED
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 froni the board of health or its agentfappointed 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 ismeededd.'
(3) Medical Examiners will investigate and certify to all'deaths supposably due to injury. These include not only' deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very import- ant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
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