USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1955 > Part 8
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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
18
COPY OF CERTIFICATE OF DEATH CERTIFICATE OF DEATH STATE OF NEW HAMPSHIRE
11 CLERK S NO
1. NAME OF
DECEASED
(Type or Print)
Jean
a. (First)
b. (Middle)
c. (Last)
( Month)
(Day)
(Year)
2. DATE
OF
DEATHJan. 24, 1955
3. PLACE OF DEATH
a. COUNTY
Rockingham
4. USUAL RESIDENCE (Where deceased lived. If institution: resid-
b. COUNTY
a. STATE
Mass.
ence before admission).
b. CITY
OR
TOWN
Exeter
c. LENGTH OF
STAY (in this place)
c. CITY (Give actual town of residence, NOT mailing address).
OR
TOWN
Winthrop
d. FULL NAME OF (If not in hospital or institution, give street address or location)
HOSPITAL OR
INSTITUTION
Exeter Hospital
d. STREET
ADDRESS
59 Summit Ave.
5. SEX
Fema le
6. COLOR OR RACE |7. MARRIED, NEVER MARRIED.
WIDOWED, DIVORCED (Specify)
Widowed
White
8. DATE OF BIRTH
11/28/1881
73
9. AGE (In years
last birthday)
IF UNDER I YEAR Months Days
IF UNDER 24 HRS Hours Min.
10a. USUAL OCCUPATION (Kind uf work done during most of working life, even if retired) Musician
10b. KIND OF BUSINESS OR IN-
DUSTRY
Organ
11. BIRTHPLACE (State or foreign country)
Oakland, Maine
12. CITIZEN OF WHAT
13. FATHER'S NAME George C. Stanley
14. MOTHER'S MAIDEN NAME
Anna B. Crommette
IS WAS DECEASED EVER IN U. S. ARMED FORCES?
(Yes, no, or unknown) | (If yes, give war or dates of service)
NO
16. SOCIAL SECURITY |17. INFORMANT
James Stanley
MEDICAL CERTIFICATION
INTERVAL BETWEEN ANSET AND DEATH days
3 months
ANTECEDENT CAUSES
Morbid con-
DUE TO
ditions, if any, giving rise to the above cause
(a) stating the underlying cause last.
(c) Primary carcinoma, origin undetermined
II. OTHER SIGNIFICANT CONDITIONS Conditions contributing to the death but not related to the disease or condition causing it.
19a. DATE OF OPERA- 19b. MAJOR FINDINGS OF OPERATION TION
20. AUTOPSY?
NO
r
1
21a. ACCIDENT
SUICIDE
HOMICIDE
(Specify)
21b. PLACE OF INJURY (e.g .. in or about
home, farm, factory, street, office bldg., etc.)
21c. (CITY OR TOWN)
(COUNTY)
(STATE)
21d. TIME
OF
INJURY
(Month) (Day) (Year) [Hour)
m
WORK
AT WORK
22. I hereby certify that I attended the deceased from Dec . 25 19 54 to Jan. 2419 59that I last saw the deceased
alive on
....
Jun. , 24 5 and that death occurred at
912 Pm., from the causes and on the date stated above.
( Degree or title)
23b. ADDRESS
Exeter, N.H.
23c. DATE SIGNED 1-25-55
24a. BURIAL, CREMATION. 24b. DATE
ENTOMBMENT, REMOVAL
Burial
\ Specify)
1/26/55
Exeter Cemetery
IF ENTOMBED
( Name of Cemetery)
LOCATION (City, Town, County State/
DATE
25. FUNERAL DIRECTOR
Carl Brewitt
ADDRESS
COUNTERSIGNED - AGENT (City Bd. of Health '
DATE
Exeter, N.H.
DATE REC'D BY TOWN OR CITY CLERK
1/24/55
CLERK'S OWN SIGNATURE
Evelyh H. Zarnowski
CLERK OF
Exeter
A true copy, Attest:
EvelynH. Jaworski Clerk of Exeter, N.H.
Dated .
2/4/55
19
V. S. 17 FEB - 9 1955
1-53-50M
X
18. I. DISEASE OR CONDITION DIRECTLY LEADING TO DEATH This does not mean the mode of dying, such as heart failure, asthenia, etc. It means the disease, injury, or complication which caused death.
(a).
Hepatic failure
DUE TO
(b) metastic carcinoma of liver
21e. INJURY OCCURRED
WHILE AT
NOT WHILE
21f. HOW DID INJURY OCCUR?
23a. SIGNATURE
Robert H. Ray
M.D.
24c. NAME OF CEMETERY OR CREMATORY 24d. LOCATION City, town, or county } 'State)
Exeter, N.H.
24e. PLACE OF BURIAL
Abbie
d'Argenzio
5 months
(If rural, give location)
None
NO.
TOWN OR CITY
RECEIVED
TOWN
OF
11 12
OLL.
5
6
THROP.
FEB-9 A.M
X
PLACE OF DEATH
SUFFOLK (County)
WINTHROP (City or Town) 1 39 GROVERS
No. REBECCA
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. 19
AVE 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.)
41 MERMAID AVE
St.
(If nonresident, give city or town and State)
Length of stay: In place of death . years. 2 .months. days. In place of residence
25.
.. years
months
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
JANUARY 28
1955
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
ALE
19
1952
to ....
JANUARY 28
19 55
I last saw HER
.alive on
JAN 28, 1955, death is said to
have occurred on the date stated above, at 12 :45 Pm.
INTERVAL BE-
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE POT
Years
Months
Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation:
HUUSE WORK
(Kind of work done during most of working life)
14 Industry
or Business:
AT HOME
15 Social Security No ..
16 BIRTHPLACE (City).
(State or country)
RUSSIA
17 NAME OF
FATHER
LOVIS SHAPIRO
18 BIRTHPLACE OF
FATHER (City)
(State or country)
RUSSIA
19 MAIDEN NAME
OF MOTHER
SARAH (CANNOT BE
LEARNED 1
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
RUSSIA
21 DR. MAURICE PAUL WOLINSKI
(Address)
41 MERMAID QUE, WINTHROP
7 NAME OF
BENJAMIN BIRNBACH
FUNERAL DIRECTOR
ADDRESS
10 WASHINGTONST DORCH.
Received and filed JAN 2.8 1959 19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR OR RACE
WHITE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
WIDOW
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
ISRAEL
WOLINSKI
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
HEMORRHAGE
CEREBRAL
3 DAYS
ANTE
Due To
CORONARY HEART
CEDENT (b)
CAUSES
DISEASE
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
If so, specify ....
(Signed)
Louis 7 Salerno
M. D.
(Address) 175 PLEASANT ST Date JAN 23 1955-
6 CHELJACOB CEM,
WOBURN
(City or Town)
Place of Burial or Cremation DATE OF BURIAL JANUARY 30
1953
50M-3-54-911887
M R-301A 1
RUCTIONS FOR . CERTIFICATE giving OF DEATH ot enter than one for each (b) and (c)
does not mean of dying, such ilure, asthenia, ans the disease, ications which th.
id conditions, ring rise to the se (a) stating rlying
itions contrib- e death but not the disease or causing death.
· Chapter 137, 1954, requires ns to print or cause or causes th on death tes.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter . Maker (Signature of Agent of Board of Health or other)
Healthe officer 1658/55
(Official Designation) (Date of Issue of Permit)
(Was deceased a
U. S. War Veteran,
(if so specify WAR)
NO.
WINTHROP
(a) Residence. No. (Usual place of abode)
WOLINSKI
PHYSICIAN - IMPORTANT
TEMALET
TWEEN ONSET AND DEATH
2/2 YRS
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 therequest 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 inelude 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 asp 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 fuherthis 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 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 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)
LUFT
MT
STANDARD
CERTIFICATE OF DEATH
Registered No.
20
No.
52 Cliff Avenue
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME .. Charlotte S. Allen (Chestnut)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 3 Nahant Avenue (Usual place of abode)
St. Revere
(If nonresident, give city or town and State)
Length of stay: In place of death .. years.
months. .days. In place of residence 55. years .months .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
(Month)
29 (Day)
1955 (Year)
8 SEX
Female
9 COLOR OR RACE White
10 SINGLE
(write the word)
MARRIED WIDOWED or DIVORCEDWidowed
"10a If married, widowed, or divorced HUSBAND of (Give maiden name of wife in full)
(or) WIFE of ... William A Allen (Husband's name in full)
11 IF STILLBORN. enter that fact here.
12 AGE .78 Years
Months Days
If under 24 hours Hours Minutes
13 Usual Occupation: At home How 016
(Kind of work done during most of working life)
14 Industry or Business:
AT
15 Social Security No.
none
16 BIRTHPLACE (City) ..
(State or country)
Cambridge.
Lass
17 NAME OF FATHER James Chestnut
18 BIRTHPLACE OF FATHER (City) (State or country) Nova Scotia
19 MAIDEN NAME OF MOTHER, Elizabeth Stanberg
1
21 Informant Mrs ...... Charlotte Rouilard
(Address)
52 cliff St. Winthrop jass
7 NAME OF
FUNERAL DIRECTOR Arthur .... S. Porcella
ADDRESS ... 876 Tinthrop Ave., Revere, Tass.
Received and filed. JAN ... 31.1955 19
(Registrar)
10 yrs
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Major findings:
Of operations
Date of operation.
What test confirmed diagnosis? Cruces
Was autopsy performed?
5 Was disease or injury in any way related to occupation of deceased? 200 If so, specify ..... (Signed (Address) 0 2
2 Date1.31
M. D 19
6 Winthrop Place of Burial or Cremation (City or Town)
DATE OF BURIAL February ....... 1, 1955
19
PARENTS
20 BIRTHPLACE OF MOTHER (City) (State or country) Nova Scotia
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial on transit permit was issued: Walter & Bakery
(Signature of Agent of Board of Health or other) Healthe Mecer 1/31/55
(Official Designation) (Date of Issue of Permit)
X
from
19
I last saw h
.. alive on
19.5 ... death is said to
4A. .m. INTERVAL BE-
have occurred on the date stated above, at.
TWEEN ONSET
AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH
a Bronchopneumonia
CEDENT (b) CAUSES ANTE Arterio gelerotic Heart Disease
19
35 0
to Seura ...
That I attended deceased
A I HEREBY CERTIFY,
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, [ if so specify WAR) No
RUCTIONS FOR . CERTIFICATE giving OF DEATH
ot enter than one for each (b) and (c)
does not mean of dying, such ilure, asthenia. ans the disease. ications which ath.
id conditions. ving rise to the se (a) stating rlying cause
itions contrib- e death but not the disease or causing death.
REVERE 50M-3-53-909098
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
1
To be filed for burial ·permit with Board of Health or its Agent.
M R-301A 1 Winthrop (City or Town)
Winthrop
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 nincteen hundred and sixteen and ninetcen 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 of 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 healthfor 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, (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 physiciaps will certify to such deaths only as those of persons to whom they have given beds de care during a fast 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.
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