USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1953 > Part 17
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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 ar the funeral is to be held, or from a person appointed to have the care of the cemetery for burial ground in which the interment is made.
Chap 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfilment of the purpose of these laws calls for the observance of the follow- Ing rules of practice :
(+)l' 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.
MOD Medical Examiners will investigate and certify to all deaths supposably l'Ifferto'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) Winthrop (City or Town) 35 Lowell Road No.
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
Registered No.
j(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
Helen C. Smiddy 2 FULL NAME.
(If deceased is a married, widowed or divorced woman, give also maiden name.) 35 Lowell Band St.
(a) Residence. No. (Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death .years. months .days. In place of residence.
15 .. years .. .months .. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
march
23
(Month)
(Day)
1753
(Year)
8 SEX
Female
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
dingle
4 I HEREBY CERTIFY,
That I attended deceased from
august 8
1952
to ..
March 23
19.
53
I last saw her
alive on
March 23
1953
death is said to
10a If married, widowed, or divorced HUSBAND of. (Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12 45% Years
Months. .Days
If under 24 hours
Hours ... . . Minutes
13 Usual
Occupation :
medical Secretary (Kind of work done during most of working life)
14 Industry or Business Randolph Byers M.D.
15 Social Security No. 012-18- 8802
16 BIRTHPLACE (City). (State or country)
East Boston
mass
17 NAME OF FATHER John E. Smiddy
PARENTS
18 BIRTHPLACE OF FATHER (City) (State or country)
Cheland
19 MAIDEN NAME
OF MOTHER
Katherine Wood
Laurence
20 BIRTHPLACE OF MOTHER (City) (State or country) masa
Katherine Smidden
21 Informant (Address) 35 Leowell Brad Min
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the barial or transit permit was issued: Matter A- Kakeres. (Signature of Agent of Board of Health of other) Health Officer 3. 24.53
(Official Designation) (Date of Issue of Permit)
50M-5-52-907046
7 NAME OF FOR Thederick mannark FUNERAL DIRECTOR
ADDRESS
East Boston
Received and filed. MAR 24 1953 19
(Registrar)
+ 1 years
ANTE
Due To
CEDENT (b) CAUSES
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Major findings: Of operations.
adenocarcinoma a Picture und Metastasis the Driver
Date of operation dept. 2, 1942 Was autopsy performed? Biopsy
What test confirmed diagnosis ?.
5 Was disease or injury in any way related to occupation of deceased? It so, specify ........ (Signed) Dorocky Cheney appleton M. D. (Address) 197 Whodoidel Cine Date 2124 1953
Winthing, macfarlane
6 Mintha Place of Burial or Cremation (City or Town)
DATE OF BURIAL march 26
19.S
C
M R-301A 1
T.
TRUCTIONS 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.
bid conditions. ving rise to the se (a) stating erlying cause
itions contrib -- e death but not the disease or causing death.
-
1
To be filed for burial ·permit with Board of Health or its Agent.
58
none PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR)
(write the word)
have occurred on the date stated above, at
7:00 P
m.
INTERVAL BE- TWEEN ONSET AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a).
adenocarcinoma of
Rectum
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 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 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 194.5.
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.
r (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.
MAR20
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
A R-301A 1
... No. PLACE OF DEATH Suffitla (County)
(City of 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.
Registered No. .. 59
16.1
f(If death occurred in a hospital or institution. St. Į give its NAME instead of street and number)
ERACiMOTZ Lucy "Kowalski" Gerasamely (If deceased is a married, widowed or divorced woman, give also maiden name.) 181 Collège IN
(a) Residence. No. (Usual place of abode)
Length of stay: In place of death years.
months .days. In place of residence ... ... years .... months
Cambridge 28 yrs
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Flermall
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
10a If married, widowed, or divorced HUSBAND Juicy Kowalesbi
(or) WIFE of
When Hemage
simetas
(Husband's name in full)
11 IF STILLBORN. enter that fact here.
12
AGE 60 Years
3
Months.
15 Days
If under 24 hours
Hours . Minutes
13 Usual
Occupation :
donnerte
(Kind of work done during most of working life)
14 Industry
or Business:
Lat home
15 Social Security No ...
021-10-3602
16 BIRTHPLACE (City).
(State or country)
Poland
17 NAME OF
FATHER
John Kowoleski
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Poland
19 MAIDEN NAME
OF MOTHER
am ?
20 BIRTHPLACE OF MOTHER (City) (State or country)
Poland
21 Informant Emily Travilla (Address) 181 Collage a EBnl
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter Q- fraker XSignature of Agent of Board of Health or other)
Theatre officer
330.03
(Date of Issue of Permit)
Mas
(If nonresident, give city or town and State) : 21 .days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF DEATH March (Month)
28, 1953
(Day)'
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
Mar 8
1953
to mar
27
53
I last saw her alive on maro 7, 1953 death is said to
3 25 am.
have occurred on the date stated above, at INTERVAL BE- TWEEN ONSET AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a) Caron Thrombosis
ANTE
CEDENT (b)
CAUSES
· Phonic Alsoconducts
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
Date of operation
€
.Was autopsy performed?
What test confirme
diagn
5 Was disease or injury in any way related to occupation of deceased? no
If so, specify
(Signed)
(Address) /SBLIR 93 DatMai 15
195
M. B.
6 Mr. Benedict.Com. W. Roxbury Place of Burial or Cremation (City or Town) DATE OF BURIAL March 31 1953
7 NAME OF
Joseph P. Squlawhi
ADDRESS 930TisST. Cambridge
Received and filed. MAR 30 1953 19
(Registrar)
Mar 28/3
Jeb-24/3
Mar 27/5
50M (B)-1-51 903586
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, cations which th.
id conditions. ing rise to the se (a) stating rlying cause
tions contrib- e death but not the disease or causing death.
Jester
2 FULL NAME.
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, if so specify WARS)
EurBrolin
St.
(Official Designation)
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 discase 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!" Isd 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.
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-sever 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's in a town, or remove thercfrom 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 of the town where the body is buried. No such permit shall be issued until therd 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 pernut 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
I. 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 front disease unrelated Get any forbr of Injury.
(1)[Board, of Health physicians will certify to such deathsonly as those of persons who. though disabled by recognized disease unrelated to any form of : have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
7(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 received a permit from the board of health or its agent aforesaid or from the cleto paso deaths from disease resulting from injury or infection related to occupation, the sudden death's 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.
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