USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1955 > Part 43
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none
Date of operation
. Was autopsy performed?
no
What test confirmed diagnosis ?.
PARENTS
19 MAIDEN NAME
OF MOTHER
Sarah Ann Ronkey
20 BIRTHPLACE OF
Date // Suen
19.55
MOTHER (City)
London
Mass (State or country) England
21
Informant.
William E .Remby
(Address)
Lynnfield Center Mass
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Mass. atter x. Make&& (Signature of Agent of Board of Health or other)
6/3/55
(Official Designation)V (Date of Issue of Permit)
50M-3-54-911887
RUCTIONS FOR CERTIFICATE giving OF DEATH ot enter than one for each (b) and (c)
does not mean of dying, such lure, asthenia, ns the disease. cations which th.
d conditions. ing rise to the e (a) stating lying cause
tions contrib- death but not he disease or ausing death.
Chapter 137. 1954, requires s to print or cause or causes h
on death es.
No.
176 Circuit Road
To be filed for burial ·permit with Board of Health or its Agent.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
NO.
That I attended deceased from
19. 55
yrs
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 'or 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 imine- 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 Chia 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 bordet C: 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 ofinjury.
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, sueh 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 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.
RES Enifertaker 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 thereis no such board, from the dierk of the town where the body is to be buried r 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.
1.1 .I, Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
V
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the follow- ing rules of practice: (1)
16:
Attending physicians will certify to such deaths only as those of persons them'they have given bedside care during a last illness from disease unrelated ans form of injury.
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 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
X
PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Town)
No.
58 Taft Ave.
J(If death occurred in a hospital or institution. St. [ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME ..
William H Gilman
(If deceased is a married, widowed or divorced woman, give also maiden name.)
58 Taft> Ave.
St.
(If nonresident, give city or town and State)
Length of stay: In place of death years .. months. days. In place of residence
5 Years
.months. .days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
June (Month) (Day)
13 1955 (Year)
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCER dowed
4 I HEREBY CERTIFY,
July
1947 to 13
last saw hi'm alive on 13 Jun, 1955 , death is said to
have occurred on the date stated above, at.
INTERVAL BE-
TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE
Years
Months.
29
.Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation :
Shoe Dealer
(Kind of work done during most of working life)
14 Industry
or Business:
Retail
15 Social Security No.
None
16 BIRTHPLACE (City)
(State or country)
New Hampshire
17 NAME OF FATHER Pliny Gilman
18 BIRTHPLACE OF
Sanbornton
FATHER (City) (State or country) New Hampshire
19 MAIDEN NAME OF MOTHER Unable to obtain
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Mass. .
Westminster
-
21 George W Gilman
(Address) 40 5th Ave. New York City N Y
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Walter & Baker
HO
(Signature of Agent of Bbard of Health or,other)
6/14/55
(Official Designation)
(Date of Issue of Permit)
V.B.V
10a If married,
Earth Deve au
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Congestive Heart Failure
weeks
ANTE
Due To Arteriosclerotic Heart
CEDENT (b)
CAUSES
Disease
years
Due (c)
Generalized Arterio-
Sclerosis
years
OTHER
SIGNIFICANT
CONDITIONS
Emphysema
15 yrs.
Major findings:
Of operations.
Date of operation
Was autopsy performed? no
What test confirmed diagnosis ?.
clinical
5 Was disease or injury in any way related to occupation of deceased ?.
10
(SignedY.
Minthrok.
Date 14 June 1955
6 Trinty
Place of Burial or Cremation (City or Town)
DATE OF BURIAL
June
15
1955
7 NAME OF
FUNERAL DIRECTOR
ADDRESS
Received and filed. s. d CUN 16 19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
(write the word)
That I Attended deceased from 55
Jun
19
HUSBAND of
(Was deceased a U. S. War Veteran. if so specify WAR)
(a) Residence. No. (Usual place of abode)
50
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH SHRIAD
To be filed for burial ·permit with Board of Health or its Agent.
Registered No.
127
M R-301A 1
STRUCTIONS FOR AL CERTIFICATE n giving E OF DEATH not enter re than one se for each ), (b) and (c)
is does not mean de of dying, such failure, asthenia, means the disease. plications which death.
rbid conditions. giving rise to the use (a) stating derlying cause
ditions contrib- the death but not to the disease or n causing death.
e :- Chapter 137, of 1954, requires cians to print or he cause or causes cath on death cates.
50M-3-54-911887
M. D.
Holderness N.H.
Plymouth
PARENTS
87 8
(Give maiden name of wife in full)
6 P.Mm.
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the'request of an undertaker or other authorized person or of any member of the family of the deceased. furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death. . . Gen. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death as required by the preceding section or by section forty-five of chapter one hundred and four- teen, shall, if the deceased, to the best of his knowledge and belief, served in the army, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that effect, specifying the war, and shall also certify in such certificate both the primary and the secondary or imme- diate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer, shall forfeit ten dollars. ·For the purposes of this section and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief expedition and the Philippine insurrection, which shall, for said purposes, be - deemed to have taken place between February fourteenth, eighteen hundred and. ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nineteen hundred and seventeen .; G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original inter- ment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the
death certificate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate. shall forthwith countersign it and transmit it to the clerk of the town for registra- tion. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45. G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of persons as are supposed to have died by violence, or by the action of chemical, thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead. .. - General Laws, Chap. 38, Sec. 6., as amended by Chap. 632, Sec. 4, Acts of 1945.
No undertaker or other persons shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit sp to dafrom 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 cemeteryfor burial ground in which the interment is made.
Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
11 12 1
() RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the follow- Ding rules of practices
(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)Solid of Health physicians will certify to such deaths only 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.
(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 ugor poisons) thermal, or electrical agents, and deaths following abortion, but Jun 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)
Mass
The Commonwealth of Massachusetts EDWARD J. CRONIN, SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent. 128
2 FULL NAME.
Lemmi
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 9 SummenttiVE uz (Usual place of abode)
St. Medford Mass
(If nonresident, give city or town and State)
Length of stay: In place of death. ....... years months days. In place of residence .. years ... .months days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX F
9 COLOR OR RACE
w
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
5-
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
AGE
Years
Months
Days
If under 24 hours
2 Hours Minutes
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry or Business:
15 Social Security No.
16 BIRTHPLACE (City).
(State or country)
Winthrop grass
17 NAME OF
FATHER
alexanderT. Lemmi
18 BIRTHPLACE OF FATHER (City) (State or country)
Metaed Breton
19 MAIDEN NAME OF MOTHER
Lucyli Di Mino
20 BIRTHPLACE OF MOTHER (City) (State or country)
Boston
1
Alexander
21 Informant. (Address) Y' Jupeur St. icalled
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: J ater &. Makes A.
(Signature of Agent of Board of Health or other)
62/13/55
(Registrar)
PARENTS
5 Was disease or injury in any way related to occupation of deceased?
If so, specify,
(Signed)
(Address)
21 Breed ST FBC Date Jeme 13
1955
6
Oak grove comerdry med. Place of Burialor Cremation (City or Town)
DATE OF BURIAL June 14 19
S
7 NAME OF
FUNERAL DIRECTOR.
Dello Russo Fun Har
ADDRESS 306 main St. medfad
WIN 16 1955 19
Received and filed
(Day)
13
1955
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
June 13
55
to ..
June 13
19
I last saw hoe
.alive on
JUNE 13
19 50 death is said to
have occurred on the date stated above, at
945A.
.. m.
INTERVAL BE- TWEEN ONSET ANO DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Immaturity
ANTE
Due To
InadequATE
CEDENT (b)
CAUSES
PLACENTA.
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
Date of operation
.Was autopsy performed?
What test confirmed diagnosis?
50M-2-19-25666
RM R-301A 1 Winthrop (City or Town)
No.
Medford 7-5-56
Winthrop Hospital
J (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)
NSTRUCTIONS FOR CAL CERTIFICATE
In giving SE OF DEATH lo not enter ore than one use for each a), (b) and (c)
his does not mean ode of dying, such rt failure, asthenia .. means the disease, nplications which death.
forbid conditions, , giving rise to the cause (a) stating nderlying cause
onditions contrib- o the death but not to the disease or on causing death.
D. Thomas Stoffer
M. D.
/(Official Designation)
(Date of Issue of Permit)
Registered No.
3 DATE OF
DEATH
JUNE
(Month)
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.
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