USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1955 > Part 7
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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 eountersign it and transmit it to the elerk 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.
RECEPPER Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The I DWA
Mulment of the purpose of these laws calls for the observance of the follow- ing rates 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 fo any form of fuiaty
Board of: Health physicians will certify to such deaths only as those of persons theo, though disabled by recognized disease unrelated to any form of mjury, 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 These include not only deaths caused directly or indirectly by traumatisme(including ,resulting septicemia), and by the action of chemical mistosy thermal, or electrical agents, and deaths following abortion, but also heath 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.
AM Statement of Cause of Death .- Physicians: see explanatory instructions on dalde bite 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, eook-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)
158 Winthrop St. No.
The Summonwealth 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.
16
Registered No.
J(If death occurred in a hospital or institution, St. Į give its NAME instead of street and number)
2 FULL NAME. Belle Augusta Floyd
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 158 Winthrop St.
St.
(If nonresident, give city or town and State)
Length of stay: In place of death. years .months. .days. In place of residence. 65
.years .months .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
January 23 1955
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
Jeb
19
46
to
January 23.
1955
I last saw
her alive on Sam
23, 19 55, death is said to
have occurred on the date stated above, at
2:15 Pm.
INTERVAL BE- TWEEN ONSET AND DEATH
11 IF STILLBORN. enter that fact here.
12
AGE.98
Years
0
Months
12 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 .....
.none
Exeter
16 BIRTHPLACE (City)
(State or country)
Maine
17 NAME OF
FATHER
Charles Thompson Seavey
18 BIRTHPLACE OF
FATHER (City)
Concord N . H.
(State or country)
19 MAIDEN NAME OF MOTHER Emily Eastman Fernald
20 BIRTHPLACE OF
(Signed).
(Address) 19 st Ulfanningtona Date 1-24
1953
MOTHER (City)
East Concord .N .H.
Winthrop Cemetery Winthrop, Mass.
6 Place of Burial or Cremation (City or Town)
DATE OF BURIAL ..... January/ 26, 1955 A. 19
7 NAME OF
FUNERAL DIRECTOR
Alfred 19. March
ADDRESS
174 Winthrop St. Winthrop.
Received and filed JAN 26 1955 19
(Registrar)
8 SEX
9 COLOR OR RACE
White
MARRIED
WIDOWED
or DIVORCED
Widowed
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
David Floyd 2nd
usband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a) .....
heart disease
Myocardial
yrs.
ANTE
CEDENT
(b)
Due To
arteriosclerosis
CAUSES generalized
(c)
Due To Senility
OTHER SIGNIFICANT CONDITIONS
Major findings:
Of operations.
Date of operation.
.Was autopsy performed?
What test confirmed diagnosis ?.
-
5 Was diseaseor injury in any way related to occupation of deceased ?. no
PARENTS
(State or country)
21 Informant Atty ...... Edward R. Thomas (Address) 154 Devonshire St. Boston I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Mass. Waller - Kaker
(Signature of Agent of Board of Health or othery
Thealth Officer
(Official Designation) (Date of Issue of Permit) 1/26/55
RUCTIONS FOR . CERTIFICATE giving OF DEATH ot enter than one for each (b) and (c)
does not mean of dying, such ilure, asthenia. ans the disease, ications which ath.
id conditions. ring rise to the se (a) stating rlying cause
itions contrib -- e death but not the disease or causing death.
M R-301A 1
SOM (B). 1-51 903586
If so, specify
M. D.
Female
10 SINGLE
(write the word)
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran. if so specify WAR)
(Usual place of abode)
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 scen 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 hury 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 hoard, 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 deathsonly as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very import- ant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the oceupation by the appropriate terms, as housekeeper-private family, cook-hotel, ete. For a person who had no oceupation 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)
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
Registered No.
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)
(a) Residence. No. (Usual place of abode)
52 Main Street
St.
Franklin, Mass.
(If nonresident, give city or town and State)
Length of stay: In place of death. years. .months 18 .days. In place of residence 2 .years months .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
January 23 1955
(Month)
(Day)
(Year)
8 SEX
Female
9 COLOR OR RACE
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Single
4 I HEREBY CERTIFY,
That I
attended deceased from
Dec 28
1954
to HANY
23
19 JJJ
I last saw her alive on JAN 23, 195J, death is said to
have occurred on the date stated above, at 2: 15PM INTERVAL BE- TWEEN ONSET AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
ADITCUTE CORONARY
THROMBOSIS
1 hr
ANTE
Due
ARTERIOSCLEROTIC
CEDENT (b) CAUSES HEART DISEASE
(c) SENILITY
3mos
OTHER SIGNIFICANT CONDITIONS
HYPERTENSION
1 year
Major findings:
Of operations.
none
Date of operation.
NONE
What test confirmed diagnos
Clinical+ Labipath
5 Was disease or injury in any way related to occupation of deceased?ha
If so, specify .......
(Signed)Jacob Cabramy M.W.
M. D.
(Address) 5602 Oderlay It DateWas, 1/29/55.
6
Union Cemetery,
Place of Burial or Cremation (City or Town)
DATE OF BURIAL January 26, 1955 19
21
Informant
(Address)
Mrs. Charles 99 Ocean View St.,
"Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter G. Baker
Hit
(Signature of Agentiof Board of Health or other)
1/ 25/30
(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, cations which ith.
id canditians, ing rise to the se (a) stating rlying cause
tians cantrib- e death but not the disease or causing death.
50M (B)-1-51 903586
7 NAME OF
FUNERAL DIRECTOR
Alfred BB. March
ADDRESS
174 Winthrop St. Winthrop, Mass.
Received and filed WAN 26 1955 19
(Registrar)
. PARENTS
11 IF STILLBORN, enter that fact here.
12
AGE 84Years5.
Months
20
Days
If under 24 hours
Hours . . Minutes
13 Usual
Occupation :.
Asst. Treasurer
(Kind of work done during most of working life)
14 Industry
Franklin Savings Bank
or Business:
15 Social Security No.
031-05-0631-A
Bath
16 BIRTHPLACE (City)
(State or country)
Maine
17 NAME OF
FATHER
Oliver Webster Lincoln
18 BIRTHPLACE OF
Was autopsy performed?
NO
FATHER (City)
Washington
(State or country)
Maine
19 MAIDEN NAME
OF MOTHER
Narcissa Williams
20 BIRTHPLACE OF
MOTHER (City)
Bath
Cammall
To be filed for burial permit with Board of Health or its Agent.
17
Winthrop Community Hospital No.
Maud Candace Lincoln
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
TO DEATH (a)
2 yrs
Franklin, Mass . (State or country) Maine
(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 for the cleceased, 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 army, natv 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 of mine , Chap. 114. Sec. 46, G. L., (Tercentenary Edition).
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 purposeJAN 2 The fulfillnatt of the purpose of these laws calls for the observance of the follow- deemed to have taken place between February fourteenth, eighteen hundreds ninety-eight and July fourth, nineteen hundred and two, and the Mexican border Ing rules of practice: 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 front 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 cipormation which can he obtained as to the deceased, or as to the manner or a INthe death, which the clerk or registrar may require. Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
Kredikft cxaminers shall make examination upon the view of the dead bodies as are supposed to have died by violence, or by the action of chemical thermal or electrical agents or following abortion, or from diseases tulltlung froor injury or infection relating to occupation, or suddenly when not disabled? y meyognizable disease, or when any person is found dead. - General Laws, ChapL.38[ Sec. 6., as amended by Chap. 632, Sec. 4, Acts of 1945.
o undertakef or other persons shall hury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to dosof the board of health or its agent appointed to issue such permits, or Whenis nosuch board, from the clerk of the town where the body is to be buried The Dnefal is to be held, or from a person appointed to have the care of the wetery ofburial ground in which the interment is made.
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.
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