USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1940 > Part 17
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9 Occupation:
Soldier(Staff Sgt.)
12 BIRTHPLACE (City)
SumterSouth Carolina
Claude B Hogan
FATHER (City)
unknown anderson
(State or country)
alabama
Annie Marie Veith Jones
unknown
Dalzell
S.C.
Relation, if any
Informant
(Address)
Recards
-
ofily
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Was - Children (Signature of Agent of Board ef7Heath or other)
Health officer 3/17/40
(Official Designationy (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
March 14, 1940
(Month)
(Day)
19 I HEREBY CERTIFY.
That I attended deceased from
19
19
I last saw h ............ alive on
19 ........ , death is said
to have occurred on the date stated above, at.
.. m.
Immediate cause of death ..
Duration
IMPORTANT
Due to ...... Poisoning by Sodium Cyanide self administered with suicidal
3/14/40
Due to ... intent.
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations
None
PHYSICIAN Underline the cause to Date of. which death should be charged sta- Of autopsy .... Diagnosis confirmed What test confirmed diagnosis ?
tistically.
20 Was disease or Injury In any way related to occupation cf deceased?
If so, specify ..............
.None
....
Ist. Lin. D.
(Signed)
(Address) Station Hospital
Fort Banks, Pass"
21
Place of Burial, Cremation or Removal.
DATE OF BURIAL
3/17/
Fam. Davono. Lager 1940
22 NAME OF
FUNERAL DIRECTOR
Charles .... R ..... Bennison
ADDRESS
Winthrop, Mass.
Received and filed 19
(Registrar)
100m-10-'39. No. 8427-e
1
Winthrop
(City or Town)
(Usual place of abode)
3 SEX
4 COLOR OR RACE
Nale
White
(or) WIFE of
6 Age of husband or wife if alive
25
7 IF STILLBORN, enter that fact here.
8
AGE
28
Years
10
Mouths ..
.......... Days
Usual
Il Social Security No.
(State or country)
13 NAME OF
FATHER
14 BIRTHPLACE OF
15 MAIDEN NAME
OF MOTHER
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
17
Fort. Banks
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION
Industry
10 or Business:
U.S. A ...... Hosp.
No ..... Station Hospital Ft .Banks Wass
St. {
2 FULL NAME Robert .... E ..... Hogan. (If deceased is a married, widowed or divorced woman, give also maiden name.)
In this community 4 yrs.
mos.
days.
(Year)
to
Date ..
3/16 19 40
(City or Town)
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital modiezl 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 famlly of the deceased, furnish for regis- tration a standard certificate of death, stating to the best of his knowledge and bellef the name of the deceased, his supposed age, the disease of which he died, defined as required hy 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 huried, 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, hy 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 physiclan, 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 healthi, or employed hy 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 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 shail be returned to the town from which it was removed within thirty- six hours after such removal, unless a permait in the usual form for the removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required hy 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 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 cicrk or registrar may require .- Chap. 114, Sos. 45, G. L., (Tercentenary Edition.)
Ne nudertaker or other person shail 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 isauc such permits, or If there is no such board. from the clerk of the town where the body is to be hurled 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 in made .... Chap. 114, See. 46. G. L .. (Tercentenary Edition)
RULES OF PRACTICE
The fulfillment of the purpose of thesc 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 hy 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 wupposably 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 sudilon deaths of persons aot 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 fallure, 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.
Sietemont 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 ilinees. If the deceased had retired from busi- ness, report the usual occupation prior to retirement. Children not gainfully employed may be returned as ct school or at home. For a woman whose only occupation was that of home housework, write houseworls. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as Nonsskeeper-private family, cook-hotel, etc. For a person who had no ocenpation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
M R-301 A :
PLACE OF DEATH
Suffolk County) Wuecherof (City or Town)
106 Bellavia
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent .~~
Registered No (If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution ..
x
(Spechy whether)
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Male
4 COLOR OR RACE
white
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word) Single
Sauf married, widowed @ divorced !? HUSBAND of
(Give ma den name of wite in full)
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive.
7 IF STILLBORN, enter that fact here.
8
8%
AGE
Years.
x
. Months.
If less than I day
x
Days
.Hours ..
Minutes
Usual
Relevat Salesman
9 Occupation:
Industry
Books Publishing
10 or Business:
Il Social Security No.
12 BIRTHPLACE (City)
(State or country}
34000
13 NAME OF
FATHER
James. M. Diew
14 BIRTHPLACE OF
FATHER (City)
(State or country)
PARENTS
15 MAIDEN NAME
OF MOTHER
YAME Julia . adelaide Barbas
16 BIRTHPLACE OF MOTHER (City) (State or country) 4.14
17 Is f. E.Diew Relation, if any Suler
Informan ..
(Address) 106 Bellum. art With
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of transit permit was issued: Www. D Childress (Signature of Agent of Board of Health or other) Quality Officer 3/19/40 (Official Designation) VI (Date of Issue of Permit)
18 DATE OF
DEATH
March
15
1940
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY.
That I attended deceased from
1
19
..... , to
19
I Just saw hw alive on.
19 .......
death is said
to have occurred on the date stated above, at 4 05 P m.
Duration
IMPORTANT
years Immediate cause of death Kahval Causes Probably
Due to
Cugina Vectra
5 min.
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations
Date of.
Of autopsy
no
What test confirmed diagnosis?
hurtigation
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
-20 Was discase or Injuryiq any way related to occupation of deceased? .
If so, specify( ....
Hayward Parker
(Signed)
isWhathad Brand of Health Date Mer 18 1940
21
Place of Burial, Cremation/or Romgyal.
DATE OF BURIAL
.19.30
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
22000
Received and filed.
(Registrar)
100m-10-'39. No. 8427-e
I
No ......
Herbert. Luther. Drew.
2 FULL NAME ..
(If deceased is a married, widowed or divorced woman, give also maiden name.) 106 Belevar care
St.
(If nonresident, give city or town and state)
years
months
X days.
In this community yrs.
yrs. " mos.
days.
(If U. S. War Veteran, specify WAR)
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state is very important. See instructions and extracts from the laws on back of certificate.
Borbón
Doras
, M. D.
Due to
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall fortbwlth, 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- tratlon a standard certificate of death, stating to the best of hls knowledge and belief the name of the deceased, his supposed age, the disease of which he died. defined as required hy section one, where game was contracted, the duration of his last iliness, when last seen alive by the physician or officer and the date of his death ... Gen. Laws. Chap. 46. Sec. 9.
NNo 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 heaith, 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 tomh other than the receiving tom'o 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 ix buried. No such permit shall be issued unti! there shali 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 lleu 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 shail make such certificate. If such a permit for the removal of a buman body, not previously interred, from one town to another within the commonwealth cannot be obtained carly enough for the purpose, the certificate of death made as above provided and In the possession of the undertaker desiring to make such removai shail constitute a permit for such removal ; provided, that such body shall be returned to the town from which it was removed within thirty- six bours after such removai, unless a permit in the usual form for tbe 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 recitai shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate. shail forthwith countersign it and transmlt 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 shali thercafter for- 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, Soo. 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 cierk 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 huriai ground in which the interment is made. ... Chap. 114, Sec. 46, G. L., (Tercentenary Edition)
RULES OF PRACTICE
The fulfilment of the purpose of these laws calls for the observ- ance of the following rules of practice:
(1) Attending physiciana wiii certify to such deaths only as these of persons to whom they have given bedside care during a last lil- ness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths oniy as those of persons who, though disabled by recognized disease un- related to any forin of injury, have died without recent medleai attendance or whose physician is absent from home when the certificate of death Is needed.
(3) Medical Examiners wili investigate and certify to all deaths supposabiy 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), thermai, or electrical agents, and deaths foliowing abortion, but aiso 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, 6. 0., heart failure. asphyxia, asthenia, etc. As principal cause name the discase causing death. As related causes, name earlier morhid con- ditions, if any, related to the principai cause and any important compileation of the principal cause.
Statement of Occupation .- Precise statement of occupation is very lenportant, 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 deatb, 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 oceupation 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-prirate family, cook-hotel, etc. For a person who bad no occupation whatever write nons.
SPACE FOR ADDITIONAL INFORMATION
R-301 Al
PLACE OF DEATH
Suffolk (County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent. 51
Registered No (If death occurred in a hospital or institution, give its NAME instead of street and number) 1 (If U. S. War Veteran, specify WAR)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
32 Locust St., Winthrop
St.
(If nonresident, give city or town and state)
In this community
5
yrs.
mos.
days.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
March
16
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY. That I attended deceased from
act
19 70
1939, to march
16
I last saw him alive on march 15, 1940, death is said
to have occurred on the date stated above, at.
1:30 Am.
Duration IMPORTANT
Immediate cause of death of Puntata
Due to
Due
48 hours
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
20 Was disoase or lajury in any way related ta occupation of deceased?
If so, specify
it and B Parken
, M. D.
(Signed)
(Address)
Winthrop Mars
Date Mar 16 1940
Winthrop
21
Winthrop
Place of Burial, Cremation or Removal18 16Sit or Town)
DATE OF BURIAL
19
22 NAME OF
FUNERAL
DIRECTOR
Richard W White
ADDRESS
147 Winthrop St. Winthrop
Received and filed
19
(Registrar)
100m-10-'39. No. 8427-e
No. 3 SEX Male (or) WIFE of 8 Usual 9 Occupation: PARENTS information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state Industry 10 or Business: 1
Winthrop
(City or Town)
L.
Winthrop Comunity Hospital
2 FULL NAME
George W. Mac Kay
(a) Residence. No.
(Usual place of abode)
Hospital
Length of stay: In hospital or institution ..
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
White
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife if alive
7 IF STILLBORN, enter that fact here.
AGE
63
Yoars
5
Months.
12
Days
Searman
Steamship
Il Social Security No.
None
Sidney
12 BIRTHPLACE (City)
rtjan N.S.
(State or country)
Cape Breton
13 NAME OF
FATHER
Alexander Mac Kay
14 BIRTHPLACE OF
FATHER (City)
Sbdney
Breton
15 MAIDEN NAME
OF MOTHER
Mary Belhaves
16 BIRTHPLACE OF
Sidney
MOTHER (City)
(State or country)
Cape Britian N.S.
Buton
17
Charles E Mac Kay
Informant.
(Address)
32 Locust St. Winthrop
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)
Cape Britian
N.S.
(write the word)
Single
years
If less than I day
Hours
Minutes
Relation, if any Brother
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial, or transit permit was issued:
Signature of Agent of Board of Health (or other)
Healthe officer
3/18/140
(Official Designation) (Date of Issue of Permit)/
Date of ..
Of autopsy Circamisma. 1 Puntata
What test confirmed diagnosis? autogenny.
6 months
1940
years
5
months
11days.
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 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. Laus, 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 thercof 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- incr shall make such certificate. If such a permit for the removal of a human body, not previously interrcd, 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 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 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.)
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