USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1940 > Part 12
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THIS CERTIFICATE CONSTITUTES SUCH PERMIT
ayer notified 3/9/40
R-301 AJ I finthrop (City or Town)
PLACE OF DEATH
Suffolk
(County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
STANDARD
CERTIFICATE OF DEATH
Fort Banks
St.
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Jeanne Alice (Gagne) Larivee
(If deceased is a married, widowed or divorced woman, give also maiden name.)
117 West Main St. Ayer Mass
St.
Aver
Ifass
(If nonresident, give city or town and state)
Length of stay : In hospital or institution ......
(Specify whether)
years
mon
Months 37
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
17th
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY
That I attended deceased from
Janus ~ 10 1940, to
February 17
, 19.
I last saw h ............ alive on.
MET .... ]7 19.Q .. , death is said
to have occurred on the date stated above, at ............. O.P ... m.
Immediate cause of death .........
with shock following tre $ sion of
4.50cc ......... c.t.a.t.d ..... load
Due to ........ orriate. .... perineal,savure, seco vary, at site of rerineorthally
Due to
Le says post operative
2 hours
...
Other conditions Voce Opencl ve ver forrt 16
(Include pregnancy within 3 months of death)
a hy alu uttalte Susre cion
Major findings :
Of operations
.... Losorption of sutures
at.sit ...... of .... perincor ... hoahy .......... 16
PHYSICIAN Underline the cause to which death should be Of autopsy ..... None. charged sta- What test confirmed diagnosis ?..... one
20 Was disease or lajury In any way related to occupation of deceased? ....... Q.
(Signed
Hcf., ... Capt. O. D.
(Address)
Et. MIS, LESS
.....
.Date .... ab ... 179.10.
Holy Cross Cemetery Lewiston Le
Place of Burial, CremationRemogao. 1gir Town)
....
DATE OF BURIAL.
19
22 NAME OF
Charles R. Bennison
FUNERAL DIRECTOR
ADDRESS
Winthrop .... Lass.
Received and filed 19
(Registrar)
100m-10-'39. No. 8427-e
AGE PARENTS information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state Industry
No
Station Hospital
3 SEX
Female
4 COLOR OR RACE
White
5a If married, widowed, or divorced
HUSBAND of
6 Age of husband or wife if alive.
32
7 IF STILLBORN, enter that fact here.
8
34
Years.
4
Months
17 Days
Usual
9 Occupation:
House work
10 or Business:
Own home
Il Social Security No.
None.
12 BIRTHPLACE (City)
(State or country)
Canada
13 NAME OF
FATHER
Edward Gagne
14 BIRTHPLACE OF
FATHER (City)
North Adams
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Canada
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION
is very important. See instructions and extracts from the laws on back of certificate.
(State or country)
Massachusetts
5 SINGLE
(write the word)
Married
MARRIED
WIDOWED
or DIVORCED
(Give maiden name of wife in full)
(or) WIFE of
Bernard .... S ........ Lari.vee
(Husband's name in full)
years
If less than 1 day
Hours
Minutes
Veronica (Unable+Fin)
17
Informant
Bernard S. Larivee ( husband
(Address)
117 West Tain St
ver Vase
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit pormit was issued:
Will Childrens (Signature of Agent of Board of Health or other)
agent Feb. 18/40
(Official Designation) (Date of Issue of Permit)
21
Relation, if any
To be filed for burial permit with Board of Health or its Agent.
Registered No
33
(If U. S.
War Veteran,
specify WAR)
(a) Residence. No ..
(Usual place of abode)
Hospital
37 10
1940
Duration
IMPORTANT
tistically.
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 regis- tration a standard certificate of death, stating to the best of his knowledge and belief the name of the dceeased, 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.
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 perinits, or if there is no such board, from the elerk 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 de- livered to such board, agent or clerk, as the case may be, a satisfac- tory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, 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 selectinen for the pur- pose, shall upon application make the certificate required of the at- tending physician. If death is caused by violence, the medical cxam- iner 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 suco 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 appcar 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 registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter fur- nish 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.)
No undertaker or other person 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 burlal ground in which the interment is made. ... Chap. 114, Sec. 46, G. L., (T'ercentenary Edition)
RULES OF PRACTICE
Tbe fulfillment of the purpose of these laws calls for the observ- ance of the following 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 ill- ness 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 un- related 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 septice- mia), 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 occupa- tion, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death. not the mode of dying. e. g., heart failure, asphyxia, asthenia, ete. As principal cause name the disease causing death. As related eauses, name earlier morbid con- ditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is very important, 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 occupation had been given up or changed on account of the discase causing death, report the usual occupation prior to illness. If the deceased had retired from busi- ness, report the usual occupation prior to retirement. 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
R-305
uffolk
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
BOSTON (City or town making return)
Registered N
1665
(City or Town) 818 Harrison avenue
St.
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
37
2 FULL NAME
Willian . O Connell
(If deceased is a married/ widowed or divorced woman, give also maiden name.)
39 le hester ane
St.
Winthrop mare
(a) Residence. No ..
(Usual place of abode)
Length of stay .: In hospital or institution ..
stop
years
months
days.
(If nonresident, gire city or town and state)
In this communityJ 2yrs.
mos.
days.
(Specify Whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
male
swhite
or DIVORCED
Sa 11 married, widowed, or divorced Gertrude M. Bradley HUSBAND of
(or) WIFE of
(Husband's name in full)
47
Years
6 Age of husband or wife if alive
7 IF STILLBORN, enter that fact here.
8
AGE 52 Years
-
Months.
Days
If less than 1 day Hours. Minutes
Usual
9 Occupation:
Proprietor
Industry
10 or Business:
Vanity store
11 Social Security No.
Each Bouton
13 NAME OF
FATHER
Edmund F. Olennell
14 BIRTHPLACE OF
FATHER (City)
(State or country)
6 Boston
mane
15 MAIDEN NAME
OF MOTHER
Rose Farren
16 BIRTHPLACE OF
MOTHER (City)
6 Boston
1 (State or country)
Stefe
Relation, if any
17
Informant.
(Address)
abola
A TRUE COPY.
James
ATTEST:
(Registrar, of city or town where death occurred)
DATE FILED
2-23-40
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH ..
February 17,1940
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY that I have investigated the death - of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury, was involved, state fully.) natural causes
complained of
precordial
20 Accident, suicide, or homicide (specify).
Date of occurrence .... Where did Injury occur? (City or town and State)
Did injury occur in or about the home, on farm, in industrial place, or in public place ?
Manner of Injury
Nature of Injury ..
While at work ?
Was there an autopsy?
21 Was disease or lojery in any way related to occupation of deceased ?.
If so, specify.
(Signed)
Tematy Leary
M. D.
(Address)
Baton
2/18/1940
22.
Place of Burial, Cremation or Removal. (City or Town)
DATE OF BURIAL
2/21/40
19
23 NAME OF
FUNERAL DIRECTOR
MI magrath.
ADDRESS.
Roceived and filed. 19
(Registrar of City or Town where deceased resided)
of death should be transmitted on Form R-305 to the clerk of the city or town in which the deceased resided as soon as possible
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
25m-10-'39. No. 8427-g
PLACE OF DEATH
(County)
1
Boston
No
(If U. S. War Veteran, specify WAR)
none
4 COLOR OR RACE 5 SINGLE
MARRIED
WIDOWED
(write the word)
(Give maiden name of wife in full)
12 BIRTHPLACE (City)
(State or country)
PARENTS
(Specify type of place)
19
TOW
S
7
6
VTHROP
MAR-91940 AM
Lakeville notificare 3/10/40
R-301 A Suffolk (County)
PLACE OF DEATH
Winthrop
1
(City or Town)
Length of stay : In hospital or institution.
3 SEX
4 COLOR OR RACE
Male
White
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
6 Age of husband or wife if alive.
7 IF STILLBORN, enter that fact here.
8
AGE
19. Years
1
Months
Days
Usual
9 Occupation:
Soldier
Il Social Security No.
None
12 BIRTHPLACE (City)
(State or country)
14 BIRTHPLACE OF
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
17
Informant
Record Office,
(Address)
Fort Banks Mass
information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
Industry
10 or Business:
U.S.Army
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION
is very important. See instructions and extracts from the laws on back of certificate.
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
(Give maiden name of wife in full)
(Husband's name in full)
Years
If less than I day
Hours
Minutes
13 NAME OF
FATHER
Fran k Dexter Charron
FATHER (City)
Rochester .. Center,
(State or country)
Massachusetts
15 MAIDEN NAME
OF MOTHER
Delia. Mary Jacques
Taunton, .... Mass.
100m-10-'39. No. 8427-e
1 HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: William S. Childrens
(Signature of Agent of Board of Health or other)
agent Feb. 18/40 (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
February 18,
1940
(Month)
(Day)
(Year)
That I attended deceased from
19 | HEREBY CERTIFY.
Feb ..... 17
19 .. 40, to.
.Feb1 ..
18
19 ... 40
I last saw h.im .... alive on ...... February .. 1.719 .. 40, death is said to have occurred on the date stated above, at .... 5:25.a.m. Immediate cause of death .. Uremic ... toxemia.
Duration IMPORTANT Several "rears ....
Due to . Nephritis .... chronic ..... inter-
stitial bilateral severe.
Due to
Arterial hypertension, severe.
Other conditions (Include pregnancy within 3 months of death)
Major findings : Of operations
Date of.
Of autopsy
What test confirmed diagnosis ?.
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
20 Was disease or Injury ig any way related to occupation of deceased?
lf so, specify.
(Signed)
N.C.Haff ,Capt. MC.
M. D.
(Address) Fort ... Ba ... nks ...... Mass ...... Date ....... F.eb !. ,19 ... 40
Place of Burial, Cremation
demovál
DATE OF BURIAL
19
22 NAME OF
FUNERAL DIRECTOR
Charles R. Bennison
ADDRESS
inthrop Nass
Received and filed 19
(Registrar)
To be filed for burial permit with Board of Health or its Agent.
Registered No.
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Frank ... Dexter ... Charron ... Jr.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.RED
Lakeside ... Ave ...
(Usual place of abode)
Hospital
......
years
months
days.
In this community
2
mos.
(Specify whether)
.......
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
No.Station ... Hospital Fort Banks
St.
(If U. S. War Veteran, specify WAR)
...........
St.
.. Lake ... ville. ... Mass
(IMionresident, give city or town and state)
PERSONAL AND STATISTICAL PARTICULARS
Woburn ,Mas s.
Relation, if any
(Official Designation)
21 Tomb
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 regis- tration 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 dicd, 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.
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 de- livered to such board, agent or clerk, as the case may be, a satisfac- tory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, 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 pur- pose, shall upon application make the certificate required of the at- tending physician. If death is caused by violence, the medical exam- iner shall make such certificatc. 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 cnough 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 tlic 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 recltal 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 registration. The person to whom the permit is so given and the physician certifying the cause of death shall thercafter fur- nish 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. )
No undertaker or other person 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 observ- ance of the following 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 ill- ness from disease unrelated to any form of injury.
(2) Board of Ifealth physicians will certify to such deaths only as those of persons who, though disabled by recognized disease un- related 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 septice- mia), 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 occupa- tion, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death incans the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbid con- ditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is very Important, 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 occupation had been given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from busi- ness, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whoze 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 housekesper-private family, cook-hotel, ete. For a person who had no oceupatlon whatever write none.
SPACE FOR ADDITIONAL INFORMATION
3 SEX 8 AGE Usual PARENTS information should be carefully supplied. AGE should be stated LAACILY. PHYSICIANS should state Industry CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and extracts from the laws on back of certificate.
100m-10-'39. No. 8427-e
I HEREBY CERTIFY that a satisfactory andard certificate of death was filed with me BEFORE the burial or transit permit was issued: Im.S. Children (Signature of Agent of Board of Health or scher) Viralthe office 2/20/40 (Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
tel.
19
1940
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY That I attended deceased from
I last saw het alive on. Feb,14, 1940, death is said
Feb 12 ...... , 199 -. Q .. , to ......... tel. 19, 1940 to have occurred on the date stated above, at 3:15 Pm. Immediate cause of death. Cerebral Hemanlage
Duration IMPORTANT
5 days
years
Due to
Other conditions
(Include pregnancy within 3 months of death)
Major findings : Of operations
Date of ...
Of autopsy
What test confirmed diagnosis ?.
Clinical
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
20 Was dlsease or Injory lo any way related to occupation of deceased?
If so, specify
Daniel T. Dusiael
M. D.
(Signed)
) 511 Pleasant mildew
Place of Burial, Crema cion Removal. (City or Town) 19.40
DATE OF BURIAL.Y ... 2
22 NAME OF FUNERAL DIRECTOR ADDRESS ....... rables
Var
all
Roceived and Med 0
To be filed for burial permit with Board of Health or its Agent.
39
Registered No (If death occurred in a hospital or institution, give its NAME instead of street and number)
(If U. S. War Veteran, specify WAR)
(If deceased is a burried widowed or divorced woman, give also maiden name.)
494 Shirley
(a) Residence. No .. ( Usual place of abode)
Length of stay : In hospital or institution.
years
months
days.
In this community 5 yrs.
6
mos.
days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
9h
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widowed
Sa If married, widowed, or divorced . HUSBAND of
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