USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1940 > Part 33
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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, froin 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 deatbs only as those of persons to whom they have given bedside carc during a last III- 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) Modical 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 abortlon, 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, etc. As principal cause name tbe disease causing death. As related causes, name earlier morbid con- ditions, if any, related to the principal cause and any important complleatlen of the principal eause.
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 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 galnfully employed may be returned as at school or at home. For a woman whose only occupation was that of home bousework, write housework. For a person engaged in domestle 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
IR-301 AJ
PLACE OF DEATH
Suffolk (County) Winthrop (City or Town) 436 Pleasant No Dennis F.
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, give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or (divorced woman, give also maiden name.)
436 Pleasant
St.
(If nonresident, give city or town and state)
Length of stay : In hospital or institution ...
(Specify whether)
years
months
days.
In this community / Dyrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
male
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word) . 18 DATE OF
married
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
56
Years
6 Age of husband or wife if alive.
7 IF STILLBORN, enter that fact here.
If less than 1 day
8 60 Years.
-
Months.
Days
Hours.
Minutes
Engineer
10 or Business:
Industry
M. E. Tel +Tel 60
11 Social Security No ..
011-10-9027
Baston
12 BIRTHPLACE (City) (State or country) mass
13 NAME OF
FATHER
Dennis napier
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Nova Scotia
15 MAIDEN NAME
OF MOTHER
Mary Carney
16 BIRTHPLACE OF MOTHER (City) (State or country) Nova Scotia Relation, if any
17 Margaret Napier, wife)
Informant (Address) 4316 Pleasant Il
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the Burial or transit pormit was issued: u. S. Childress Signature of Agent of Board of Health ar other) Wealth Officer 6/4/40
(Official Designation (Date of Issue of Pofmit)
MEDICAL CERTIFICATE OF DEATH
DEATH
June
2
( Month )
(Day)
(Year)
That I attended deceased from
19 I HEREBY CERTIFY
may
1
19.3.9., to.
2
19.4.0
I last saw him .alive on ..
June 2, 194U, death is said
to have occurred on the date stated above, at ...
1.1A.m.
Immediate cause of death ........
Coronary Thrombosez
Duration IMPORTANT 1939
Due to
Hypertension
Due to
Other conditions
(Include pregnancy within 3 months of death)
Major findings : Of operations
Date of
Of autopsy
What test confirmed diagnosis ?
Cardio-grafiti
charged sta- tistically.
20 Was disease ur lujury in any way related to occupation of deceased?
If so, specify.
Henry LOhumaines
M. D.
(Signed)
726 Sure 599 86 Date Jums 3 1940
(Address)
Place of Burial, Cremation or Removal.
DATE OF BURIAL
21
Winthrop
0
Winthrop
(City or Town)
June 5 1940
FUNERAL DIRECTOR
22 NAME OF
Charles H. Tregnor
ADDRESS
East Boston
1
Received and filed 19
(Registrar)
100m-10-'39. No. 8427-e
1 AGE PARENTS 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. information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state Usual
St. 3
napier
(If U. S. War Veteran, specify WAR)
na
(a) Residence. No ...
(Usual place of abode)
1940
PHYSICIAN Underline the cause to which death should be
9 Occupation:
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. Laws, Chap. 46. Sec. 9.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove thercfrom 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 sclectmen 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 carly 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 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 hcreunder. 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 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 deccased, 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 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 fonnd doad.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not the mode of dying, c. 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 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 kousckosper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
A R-301 A
PLACE OF DEATH
Suffolk
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.
108
Registered No
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Loring R. Cogswell
(If deceased is a married, widowed or divorced woman, give also maiden name.)
128 Bartlett Ed.
.St.
(If nonresident, give city or town and state)
35
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
Ward Fullerton Cogswell
(Give maiden name of wife in full)
(Husband's name in full)
61
Years
If less than 1 day
Hours
Minutes
100m-10-'39. No. 8427-e
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the buffal or transit permit was issued: Www. D. Children (Signature of Agent of Board of Hea for the Health Officer 6/4/40
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
2
1940
(Year)
19 | HEREBY CERTIFY.
19.
death is said
.... ,
to.
...
I last saw hh alive on.
19
19
to have occurred on the date stated above, at.
4 P
,.m.
Immediate cause of death Watmal Ciman
Duration
IMPORTANT
Preach Couch bilitate of that
June 2 19%
Due to
Due to
mutual sturni
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations
Of autopsy
What test confirmed diagnosis? Washieti
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
20 Was disease or Injury in any way related to occupation of deceased? .....
If so, specify.
Raymond
8 Pucken
(Signed) .
M. D.
(Addre:
Writing Brand 1 /huth Date June Y 1970
Winthrop
21 Winthrop
(City or Town)
Place of Burial, Cremation or Removal 940
DATE OF BURIAL
Richard 96 While
19
22 NAME OF FUNERAL DIRECTOR
ADDRESS
147 Winthrop St., Winthrop
Receivod and filed 19
(Registrar)
19.38
13 NAME OF
FATHER
Maynard Cogswell
17 Relation, if any
Sterling L. Cogswell Son "58 Bartlett Rd., Winthrop
.........
years
months
days.
In this community
yrs.
mos.
days.
(County)
Winthrop
1
(City or Town)
(a) Residence. No ..
(Usual place of abode)
Length of stay : In hospital or institution ..
3 SEX
4 COLOR OR RACE
White
Male
5a If married,
HUSBAND of
(or) WIFE of
6 Age of husband or wife if alive
7 IF STILLBORN, enter that fact here.
8
73
9
AGE
Years
Months
Days
Usual
9 Occupation:
Sa le sman
10 or Business:
AGE should be stated EXACTLY. PHYSICIANS should state
11 Social Security
No.
none
12 BIRTHPLACE (City)
Morristown
(State or country)
Nova Scotia
14 BIRTHPLACE OF
Morristown
FATHER (City)
(State or country)
Nova Scotia
15 MAIDEN NAME
OF MOTHER
Jane Palmer
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Nova Scotia
Informant
(Address)
information should be carefully supplied.
is very important. See instructions and extracts from the laws on back of certificate.
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION
Industry
Whole sale Beef
No. 128 Bartlett Rd. Winthrop
St.
(If U. S. War Veteran, specify WAR)
(Month)
(Day)
That I attended deceased from
1
...
.Date of.
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. 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 sball 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 wbo 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 carly 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 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 deatb 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, sball 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 thercof 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 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, 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 ef 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 kousework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekooper-private family, cook-hotel, etc. For a person who had no oceupatlon whatever write none.
SPACE FOR ADDITIONAL INFORMATION
1 R-301 A
Suffolk (County)
Winthrop
(City or Town)
No. 86 Bartlett Rd.,
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 GO
Registered No. (If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Frank Bates Walker
(If deceased is a married, widowed or divorced woman, give also maiden name.)
86 Bartlett Rd ..
St.
(If nonresident, give city or town and state)
In this community
27
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
5a lf married, widowed. Mary Hodgkins HUSBAND of
(Give maiden name of wife 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 AGE 65 Years 11 Months 15 Days
If less than I day
Hours
Minutes
Usual Civil Engineer
9 Occupation:
Industry Eastern Mass.R.R.Co.
10 or Business:
024-01-3426
11 Social Security No.
Travers City
12 BIRTHPLACE (City)
(State or country)
Michigan
13 NAME OF FATHER
James Walker
14 BIRTHPLACE OF
FATHER (City)
Unknown
(State or country) Ireland
15 MAIDEN NAME
OF MOTHER
Harriet Broadhead
16 BIRTHPLACE OF Urbana MOTHER (City) .... (State or country) Illinois
100m-10-'39. No. 8427-e
17
Informant Mary H.Walker
Relation, if any wife
(Address) 86 Bartlett Rd. Winthrop Mass
1 HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Nu.S. Children (Signature of Agent of Board of Health or other) Health Officie 6/5/40 (Date of Issue of Permit)
(Official Designation)
18 DATE OF
DEATH
6
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY. That I attended deceased from
10, 1940, to ....... , 19 ....... 02. K .... I last saw h.w .alive on .... ... 2, 19.4 .. 47 death is said Duration IMPORTANT to have occurred on the date stated above, at ........... 2.,f.m. Immediate cause of death ... Husmunkager
Due to
Jerome Criterio Seleção
DueGo
Other conditions (Include pregnancy within 3 months of death)
Major findings :
Of operations
PHYSICIAN Underline the cause to which death
Of autopsy
What test confirmed diagnosis ?.
should be charged sta- tistically.
20 Was disease or lajuty in any way related to occupation of deceased?
If so, specify.
(Signed)
M. D.
(Address)
21 19 (City or Town) 40 ...... Woodlawn Everett ....... Place of Burial, Cremation os Bemgal. DATE OF BURIAL
22 NAME OF FUNERAL DIRECTOR
P. E. Parku
ADDRESS 300 Meridian St., E. Boston
Received and filed
19
(Registrar)
AGE should be stated EXACTLY. PHYSICIANS should state
is very important. See instructions and extracts from the laws on back of certificate. CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION information should be carefully supplied.
1
PLACE OF DEATH
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