Town of Winthrop : Record of Deaths 1940, Part 12

Author: Winthrop (Mass.)
Publication date: 1940
Publisher:
Number of Pages: 494


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1940 > Part 12


Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).


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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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