USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1955 > Part 61
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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 or the funeral 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).
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.
(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
April 28 -1918
DATE OF DISCHARGE
June 2 - 1919
RANK, RATING
CorporAl
ORGANIZATION AND OUTFIT
ARmy Com-147 Jul.
SERVICE NUMBER
2706234
M R-301A 1
PLACE OF DEATH No.
X Sul falk (County) 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 pormit with Board of Health or its Agent.
Registered No. 186
inti Vogreta !! (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)
(If nonresident, give city or town and State)
Length of stay: In place of death .years. months. .... days. In place of residence ...
32 years
months .. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
SEPTEMBER 6
(Month)
(Day)
1955 (Year)
4 I HEREBY CERTIFY.
That I attended deceased from
Nov. 5.
1952
to ..
SEPT. 6
1955
I last saw h.E.R .. alive on.
Sept. 6
19.
death is said to
have occurred on the date stated above, at. 6:10 P.m.
INTERVAL BE-
10a If married, widowed, or divorced
HUSBAND of.
George E, Leet
(Husband's name in full)
DISEASE OR CONDITION DIRECTLY LEADING
TO DEATH
(a)
ARTERIOSCLEROTIC
HEART DISEASE
TWEEN ONSET AND DEATH 3 YRS.
11 IF STILLBORN, enter that fact here.
12
AGE
84,
0
Months
25 Days
If under 24 hours
Hours .... ... Minutes
13 Usual
Occupation:
(Kind of work done during most of working life)
14 Industry
or Business:
at home
15 Social Security No. waltham
16 BIRTHPLACE (City).
(State or country)
17 NAME OF
FATHER
Legge Confi
Major findings:
Of operations.
NONE
Date of operation.
Was autopsy performed ?. NO
What test confirmed diagnosis ?.
CLINICAL + LABORATOR
PARENTS
19 MAIDEN NAME
OF MOTHER
Catherine Fairch
20 BIRTHPLACE OF MOTHER (City) (State or country)
Menrge Leet
Informant (Address) Buvaugon cal
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Vialle G Kaker
(Signature of Agent of Board of Health of ther)
HO.
Sikt. 7/ bs
(Date of Issue of Permit)
AV
RUCTIONS FOR . CERTIFICATE
giving OF DEATH not enter than one for each (b) and (c)
does not mean of dying, such ilure, asthenia. ans the disease, ications which ath.
id conditions, ving rise to the se (a) stating Flying
itions contrib- e death but not the disease or causing death.
IOOM-10-53-910621
6
Place of Burial or Grenation {City of Town)
# 8
7 NAME OF
DATE OF BURIAL FUNERAL DIRECTOR Aawards Rurales
ADDRESS
180 Winthrop Se
Received and filed
Seth, 9, 1955
19
(Registrar)
GyRS.
Due To
(c)
OTHER
SIGNIFICANT
CONDITIONS
ARTHRITIS
HYPERTROPHIC
SYRS.
5 Was disease or injury in any way related to occupation of deceased? NO.
If so, specify
(Signed)
MauretE Traunstein
M. D.
2 SHIRLEY SICH DIE SEPT 6
With
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Nova Scotia
Elabour
sh
1
2 FULL NAME
Mande alice(Cook) Let
(If deceased is a married, widowed or divorced woman, give also maiden name.)
111
(a) Residence. No. .
(Usual place of abode)
Collage Park Road
9 COLOR OR RACE
10 SINGLE
(write the word)
8 SEX
Female Culite
MARRIED
WIDOWED Referred
or DIVORCED
(Give maiden name of wife in full)
(or) WIFE of ...
ANTE
Due To
GENERALIZED
CEDENT (b)
CAUSES
ARTERIOSCLEROSIS
(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 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, on).
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 frontinjury or infection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead. .. - General Laws, Chap,138 Sec. 6.) as amended by Chap. 632. Sec. 4. Acts of 1945.
Nib undertaker pr 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 froth 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. he held or from a person appointed to have the care of the cemetery or burial ground in which the interment is made.
L& G. L., (Tercentenary Edition).
IRO
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the follow- ing rules of practice: (1) Attending physician Is 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
-
-
X PLACE OF DEATH
Suffolk (County)
Winthrop (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.
187
2 FULL NAME .. Clarence William Mac Donald (If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 41 ... Villow .... Ave ..
(Usual place of abode)
Length of stay: In place of death ....... .years months 4 days. In place of residence 35 years. .months days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
September
8.
1955
(Month)
(Day)
(Year)
8 SEX
Male
White
9 COLOR OR RACE
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
1955
4 I HEREBY CERTIFY,
That I attended deceased
from
Sept. 5° the
19.
to ..
Sept 8, 1955
19
10a If married, widowed, or divorced
HUSBAND of.
Edna Louise Hiltz
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Broncho pneumonia
(termine)
ANTE
Due Toeyebro vascular
CEDENT (b) ...
CAUSES
thrombosis
Due
To arteriosclerosis
(c)
generalized
ULRICHIER
Ciuri cular fibriration
OTHER
SIGNIFICANT
CONDITIONS
Fibrillation
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? If so, specify
(Signed).
599 Kaduylanac Date 9-9
M. D.
6 Winthrop Cemetery Winthrop
Place of Burial or Cremation (City or Town)
DATE OF BURIAL .. September 12 1955 19
7 NAME OF
FUNERAL DIRECTOR
Alfred 15. Warst
ADDRESS 774 Vinterpe 1955 Winthrop,
Received and filed. 19
(Registrar)
TWEEN ONSET AND DEATH 11 IF STILLBORN, enter that fact here.
12
AGE
7.5Years
3Months
1.7Days
If under 24 hours
.. Hours
.Minutes
13 Usual
Occupation:
paper hanger
(Kind of work done during most of working life)
14 Industry
Or Business Commercial painting Co.
15 Social Security No.0.1.0-09-9439
16 BIRTHPLACE (City) ..
(State or country)
Nova Scotia
17 NAME OF
FATHER
John Mac Donald
18 BIRTHPLACE OF
FATHER (City)
Lunenberg
(State or country)
Nova Scotia
19 MAIDEN NAME
OF MOTHER
Mary Ann Knickle
20 BIRTHPLACE OF
19 .... ..
MOTHER (City)
Lunenberg
(State or country)
Nova Scotia
21
Informant.
Mrs ...................... MacDonald
(Address)
41 Willow Ave. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Mass. Walter 6. 12aker
(Signature of Agenf of, Board of Health or other)
HO Sept: 12/55
(Official Designation) (Date of Issue of Permit) X
RUCTIONS FOR L CERTIFICATE
giving CF DEATH not enter than one · for each (b) and (c)
does not mean of dying, such ilure, asthenia, ans the disease. ications which ath.
id conditions, ving rise to the se (a) stating erlying cause
itions contrib- te death but not the disease or causing death.
50M-10-52-908091
5.
M R-301A 1
No. . Winthrop Community ... Hospital
Registered No.
f(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)
N.O ..
St. (If nonresident, give city or town and State)
I last saw h 1 MM alive on
Sepr. 8, 1955
death is said to
have occurred on the date stated above, at 8:25P.
INTERVAL BE-
1 horas
11 days
Luenberg
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 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., (Tercentenars 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 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 funeralis to be held, or from a person appointed to have the care of the cemetery on burial ground in which the interment is made.
Chap !! haf Sed. 46, LC, (Tercentenary Edition).
THROP.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the follow- ing rules of
(1) Attendulg 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.
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