USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1955 > Part 11
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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 So gejsting As are supposed to have died by violence, or by the action of chemical, thermal or clectrical agents or following abortion, or from diseases resulting from injury or infection relating to occupation, or suddenly when not Today recognizable disease, or when any person is found dead. . - General 38, Scc. 6., as amended by Chap. 632, Scc. 4. Acts of 1945.
Noundertaker or other persons shall bury a human body or the ashes thereof wheir have been brought into the commonwealth until he has received a permit so to dofrom the board of health or its agent appointed to issue such permits, or if there is dasuch board, from the clerk of the town where the body is to be buried or The Vunetal is to be held, or from a person appointed to have the care of the cemetery of burial ground in which the interment is made.
Chap. 114, Sec.46, G. L., (Tercentenary Edition).
6 in RULES OF PRACTICE
Thefulfillment of the purpose of these laws calls for the observance of the follow- Ting 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.
Board of:Health physicians will certify to such deaths only as those of orsons 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 occup :.- 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
X
PLACE OF DEATH
Suffolk (County)
M R-301A 1 Winthrop (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.
30
No. Winthrop Community Hospital
2 FULL NAME .. . Helen Marion Small
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 26 .... Beacon .... Street
St.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death years ... .months5. .. days. In place of residenc 15 years. . ... . . months .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR OR RACE
10 SINGLE
(write the word)
MARRIED
WIDOWED married
or DIVORCED
female white
4 I HEREBY CERTIFY,
That I attended deceased from
que 22 19
51
to
feb. 10
19
5
last saw
.alive on.
Feb. 10
195
.. , death is said to
have occurred on the date stated above. at INTERVAL BE- TWEEN ONSET AND DEATH
TO DEATH (a)
Hemorrhage
ANTE
Due To
Hypertension
CEDENT (b)
CAUSES
Carterios CLEROTIC)
Due TChronic INTERST (c) ITIAL NEPHRITIS
OTHER
SIGNIFICANT
CONDITIONS
GOUT
2 wks.
Major findings:
Of operations.
NONE
Date of operation.
NONE
Was autopsy performed ?. CLINICAL + Lab.
5 Was disease or injury in any way related to occupation of deceased?
(Address) 562 Heerlen
.. Date 2. /11 /55
sagamore Cemetery ..... "Place of Burial or Cremation For South N. H. DATE OF BURIALEntombment Feb 12 1955 1
7 NAME OF
FUNERAL DIRECTOR
Lefred 15 March
ADDRESS
174 Winthron St. Winthrop
Received and filed FEB 14 1955 19
(Registrar)
11 IF STILLBORN. enter that fact here.
12
4 days AG 160 Years
7
Months 25 Days
If under 24 hours
Hours ..
Minutes
13 Usual
Occupation:
housewife
(Kind of work done during most of working life)
14 Industry
or Business:
own ... home
15 Social Security No .....
014-22-9827
16 BIRTHPLACE (City) .. (State or country) Mass
Medford.
17 NAME OF
FATHER
Frank E. Lucia
18 BIRTHPLACE OF
FATHER (City)
ver gennes
(State or country)
vermont
19 MAIDEN NAME
OF MOTHER
Julia Welch
NO Sig Jawb I Chaves m. w M. D. MOTHER (City) Medford 20 BIRTHPLACE OF
(State or country) Mass.
21 Informant Norman A Small
(Address)
26 Beacon St. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Mags. Walter & Bakers
(Signature of Agent of Board of Health or other) Health Affecte 2/11/55
(Official Designation) (Date of Issue of Permit)
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 tth.
id conditions, ing rise to the se (a) slating rlying cause
itions contrib- e death but not the disease or causing death.
-
SOM (B)-1-51 903586
5.
Registered No.
[(If death occurred in a hospital or institution,
St. { give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
-
(Was deceased a
U. S. War Veteran,
if so specify WAR)
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of Norman Aldrich Small
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEANING chal
9:45 AM
2 yrs.
6 mois
NO
What test confirmed diagnosis?
PARENTS
(Year)
3 DATE OF
DEATH
February
(Day)
:1955
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 whoni 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 behef the name of the deceased, his supposed age. the
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 disease of which he died, defined as required by section one, where He CE I Vatanled by recognizable disease, or when any person is found dead. - General contracted, the duration of his last illness, when last seen alive by the physical 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 Which have been brought into the commonwealth until he has received a permit 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 /servedmy the) army, navy or marine corps of the United States in any war in which n has been engaged insert in the certificate a recital to that effect, specifying thenac lama shall also certify in such certificate both the primary and the secondary hi imme- diate cause of death as nearly as he can state the same. For neglect to comp y Chap. 114, Sec. 46, G. L., (Tercentenary Edition). 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 fottv-seven RULES OF PRACTICE Cal of said chapter one hundred and fourteen, the word "war" shall includethe China relief expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred HAN Me fulfillment of the purpose of these laws calls for the observance of the follow- One rules of practice: ninety-cight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nineteen hundred and seven G. L. Chap 46. Sec. 10.
N ·· 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 such permits, or if there is no such board, from the clerk of the town foste 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 perniit 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, Scc. 45, G. L., (Tercentenary Edition).
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 sóito 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 mieteryor burial ground in which the interment is made.
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 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)
A R-301A 1 Winthrop (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.
31
j(If death occurred in a hospital or institution, St. Į give its NAME.instead of street and number)
2 FULL NAME. Frederick Sinclair Davis
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
46 Lewis Ave
(Usual place of abode)
. St.
(If nonresident, give city or town and State)
Length of stay: In place of death.
40years.
.months.
days. In place of residence 40
.years
months
... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
February 11,1955
(Day)
(Year)
(Month)
4 I HEREBY CERTIFY.
That I attended deceased from
October
1924
..
to .. .
Feb.
.. ..
1955
I last saw him alive on
Feb. 11 ..... 1955 death is said to
have occurred on the date stated above, at
8:45 A.m.
10a If married, widowed, or divorced
HUSBAND of .. Emma Amanda Rodney
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN. enter that fact here.
12
AGE70.
.. Years
1
Months
6.
Days
If under 24 hours
Hours
Minutes
ANTE
CEDENT (b)
CAUSES
e Arteriosclerosis
5 yrs
Due To (c)
OTHER SIGNIFICANTBronchopneumonia CONDITIONS (Terminal)
3 days
Major findings:
Of operations.
Date of operation
Was autopsy performed?
No
What test confirmed diagnosis ?.
Clinical
No
5 Was disease or injury in any way related to occupation of deceased?
If so, specy Deneles Lilia
(Signed)
M. D.
(Address) Winthrop, Mas Date 2/11/1955
Place of Burial of Cremation (City or Tawny
DATE OF BURIAL February 14 1955 1 ... 19 ..
7 NAME OF
FUNERAL DIRECTOR
Ulfed 13. March
ADDRESS
174 Winthrop St
Winthrop Mass.
Received and filed. FEB 14 1955
19
(Registrar)
PARENTS
19 MAIDEN NAME
OF MOTHER
Anna Otto
20 BIRTHPLACE OF
MOTHER (City)
Scranton
(State or country)
Penna,
21 Informant Mrs. Frederick S. Davis (Address) 46 Lewis Ave, Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit perent was issued:
walter 6.
Bakar
(Signature of Agent of Board of Health or other)
(Official Designation) Offer 2/14/55
(Date of Issue of Permit)
VIV
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 uth.
id conditions. ing rise to the se (a) stating rlying cause
tions contrib- e death but not the disease or causing death.
SOM (B)-1-51 903586
6
Winthrop Cemetery Winthrop, Mass
14 Industry
or Business:
General Insurance Business
15 Social Security N035-26-0699
Scranton
16 BIRTHPLACE (City). (State or country) Penna
17 NAME OF
FATHER
William Sinclair Davis
18 BIRTHPLACE OF
FATHER (City)
Scranton
(State or country)
Penna.
13 Usual OccupatioRetired Insurance Broker (Kind of work done during most of working life)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Cerebral Hemorrhage
INTERVAL BE- TWEEN ONSET AND DEATH 1 yr.
9 COLOR OR RACE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
married
8 SEX
male
white
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran. if so specify WAR) NO
Registered No.
No. 46 Lewis ... Ave.
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 u has been engaged. insert in the certificate a recital to that effect, specifying ano E. Vna 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 forfait ran cholas For the purposes of this section and of sections forty-five, forty-six and forteve I 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 Junta and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nineteen hundred and sourtech. G. L. Chap. 46. Sec. 10.
No undertaker or other person shall bury or otherwise disposemf's human body in a town. or remove therefrom a human body which has not bedy buried, until hel has received a permit from the board of health, or its agent apportennulissue such permits, or if there is no such board, from the clerk of the town here 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 (1) Attending physicians will certify to such deaths only as those of persons Ito 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 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 Hersons found dead.
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