Town of Winthrop : Record of Deaths 1940, Part 68

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1940 > Part 68


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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 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 housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.


SPACE FOR ADDITIONAL INFORMATION


MR-301 A


1


PLACE OF DEATH Julfolk (County) 11 Winthrop


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 228


Registered No ..


§ (If death occurred in a hospital or institution. St. ¿ give its NAME instead of street and number)


(If deceased js a married, widowed or divorced woman, give also maiden name.)


292 Winthrop


St


(If nonresident, give city or town and state)


In this community 2 $ yrs. mos. days.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH.


(Month)


(Day)


(Year)


19 I HEREBY CERTIFY, That I attended deceased from


1943, to 19 45


I last saw ha alive on wenn 18, 19 45, death is said to have occurred on the date stated above, at .... 11.45 P .. m.


Immediate cause of death. ...........


Duration IMPORTANT 111


Due to


che attendos.


Gatan recursos


Due to.


Other conditions.


(Include pregnancy within 3 months of death)


IMPORTANT


PHYSICIAN


Major findings: Of operations.


Date of.


Of autopsy.


What test confirmed diagnosis ?.


20 Was disease or injury in any way related to occupation of deceased? no


If so, specify


(Signed) ...


(Address) I Wishhow


2. M. D.


.Date ....


12/10 1940


21 Holy Cross Com.


Place of Burial, Cremation or Removal.


(City or Town)


maldon


DATE OF BURIAL December


21


19 40


22 NAME OF


FUNERAL DIRECTOR


Ed. 8. Jani


ADDRESS.


201 Bowdown St Dorchester


Received and filed 19


(Registrar)


is very important. See instructions and extracts from the laws on back of certificate.


100m-2-'40-D-729-a


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial pr transit permit was issued: Im Slehelder


(Signature of Agent of Board of Health or other)


140


Dec. 20 - 1940


..... ..... (Official Designation) (Date of Issue of Permit)!


(write the word)


Single


Sa If married, widowed, or divorced HUSBAND of


(Give malden name of wife in full)


(or) WIFE of


(Husband's name in full)


6 Age of husband or wife if alive .. .years


7 IF STILLBORN, enter that fact here.


AGE


8 82. Years Months. Days!


If less than 1 day Hours Minutes


Usual


9 Occupation :...


A1 hors


Industry 10 or Business :.


11 Social Security No ..


East Boston


12 BIRTHPLACE (City)


(State or country)


mardi,


13 NAME OF


FATHER


Thomas Lana


Lana


PARENTS


14 BIRTHPLACE OF FATHER (City) (State or country) ruland


15 MAIDEN NAME


OF MOTHER


mary d. Norton


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


Oreland


17 Chusustras Morris (Nephew)


Informant


(Address)


292 Winthrop & Winthrop


Relation, if any


(If U. S. War Veteran. specify WAR)


Winthrop


(a) Residence. No ..


(Usual place of abode)


Length of stay: In hospital or institution ..


none


years


months


days.


(Specify whether)


3 SEX


4 COLOR OR RACE


5 SINGLE


MARRIED


WIDOWED


or DIVORCED


18


1940


Underline the cause to which death should be ¡charged sta- tistically.


CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION ... ..


(City or Town) 292 Winthrop No .. mary B. Dans 2 FULL NAME


EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE


RETURN OF CERTIFICATES OF DEATH


A physician or registered hospital medical officer shall forthwitb, after the death of a person whom be 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, furnisb for registration a standard certificate of death, stating to the best of bis knowledge and belief tbe name of the deceased, his supposed age, the disease of wbicb he died, defined as required by section one, where same was contracted, tbe duration of bis last illness, wben 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 buman body in a town, or remove tberefrom 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 anot ber, or from one grave or tomb other than the receiv- ing tomb to another in the same cemetery, until he bas received a permit from the board of bealtb or its agent aforesaid or froin the clerk of tbe town where the body is buried. No such permit shall be issued until there shall bave been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of tbe attending physician, if any, as required by law, or in lieu tbereof a certificate as bereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is in- sufficient, a physician wbo is a member of the board of health, or em- ployed by it or by tbe selectmen for the purpose, shall upon application make tbe certificate required of tbe attending physician. If death is caused by violence, the medical examiner shall make sucb certificate. If such a permit for the removal of a human body, not previously interred, from one town to anotber within the commonwealth cannot be obtained early enougb for the purpose, tbe certificate of death made as above provided and in tbe possession of the undertaker desiring to make such removal sball constitute a permit for sucb removal; provided, that such body sball be returned to the town from which it was removed witbin thirty-six hours after such removal, unless a permit in the usual form for the re- moval of such body has been sooner obtained bereunder. If the deatb certificate contains a recital, as required by section ten of chapter forty- six, tbat 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 sball 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 tbe physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the deatb, which tbe 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 bave been brought into the commonwealth until he has received a pernit 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 observance of tbe 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 illness from disease unrelated to any form of injury.


(2) Board of lIealth physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of deatb is needed.


(3) Medical Examiners will investigate and certify to all deatbs supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from Injury or infection related to occupation, tbe 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 wbich causes death, not the mode of dying, e. g., heart failure, aspbyxia, asthenia, etc. As principal cause name tbe disease causing deatb. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of tbe principal cause.


Statement of Occupation .- Precise statement of occupation is very important, so that tbe relative bealthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation bad 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 business, 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 bousework, write housework. For a person engaged in domestic service for wages, bowever, 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


61 R-301 AJ!


PLACE OF DEATH


Sufflok (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. 229


Registered No ..


St. 1 (If death occurred in a hospital or institution, give its NAME instead of street and number)


2 FULL NAME


Alfred ... Illingworth


(If deceased is a married, widowed or divorced woman, give also maiden name.)


(a) Residence. No.


193 Main


St.


(If nonresident. give city or town and state)


(Usual place of abode)


Length of stay : In hospital or institution ..


(Specify whether)


years


months


days.


In this community 20yrs.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


December


20, 1940


(Month)


(Day)


(Year)


12 I HEREBY CERTIFY That I attended deceased from


last s&w h .....!.... 1.alive on.


December 19/40 death is said


to have occurred on the date stated above, at 11:30 P.M.


Immediate cause of death .....


Bulbar


death Palay


Duration IMPORTANT 1940 ...


........


1939


PHYSICIAN Underline the cause to which death should be charged sta- tistically.


20 Was disease or lajory la acy way related to occupation of deceased?


If so, specify)


haus,


1.80


....


(Signed) Jacob


, M, D.


(Ad


(s) 562 Shirley St Date 12/21 1940


21


winthrop


Place of Burial, Cremation


DATE OF BURIAL


De Removal2


1940


(City or Town)


(Address) 6 Ashland Ave Methuren Mass.


I HEREBY CERTIFY that a satisfactory standard certificate of doath was filed with me BEFORE the burial or transit permit was issued:


Children


(Signature of Agent of Board of Health ofother)


health Officer (Official Designation) (Date of Issue 6: Perunit)


12/21/40


19


(Registrar)


Winthrop


1


(City or Town)


3 SEX


4 COLOR OR RACE


Male


White


(or) WIFE of


6 Age of husband or wife if alive


7 IF STILLBORN, enter that fact here.


8


79 19


4


AGE


Years


Months


9 Occupation:


Industry


Il Social Security No.


PARENTS


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


England


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


100m-10-'39. No. 8427-e


N.B. WRITE PLAINLY WITH INFADING RICACKOIN


HAVIALALIVIL SIVUIL De careluny supplied. AUE should be stated EXACTLY. PHYSICIANS should state


10 or Business:


ool Shop


! 5 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCEMarried


Sa If married, widowed, ondira A Hinds


HUSBAND of


(Give maiden name of wife in full)


(Husband's name in full)


77


Years


If less than I day


3


Days


Hours


Minutes


Usual


Wool Sorter


12 BIRTHPLACE (City)


Bradford


(State or country)


England


13 NAME OF


FATHER


Abraham


Illingworth


14 BIRTHPLACE OF


FATHER (City)


(State or country)


England


15 MAIDEN NAME


OF MOTHER


Mary Lister


Major findings :


Of operations


none


.Date of.


Of autopsy


What test confirmed diagnosis Chimieal X


launutmi


Due to


arteriosclerosis


Due to


Other conditions


(Include pregnancy within 3 months of death)


17 Informant Percy Illingworth


Relation, if any Son


22 NAME OF


FUNERAL DIRECTOR


ADDRESS


y /mass.


Received and filed


1936 to


december 20040


(If U. S. War Veteran, specify WAR)


No. 193 Main St.


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 hest of his knowledge and helief 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 hy the physician or officer and the date of his death ... Gen. Laws, Chap. 46. Sec. 9.


No undertaker or other person shall hury or otherwise dispose of a human hody in a town, or remove therefrom a human hody which has not heen 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 hoard, 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 tomb to another in the same cemetery, until he has received a permit from the hoard of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall he issued until therc shall have been de- ivered to such board, agent or clerk, as the easc may be, a satisfac- ory written statement containing the facts required by law to he returned and recorded, which shall he 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 he obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed hy it or hy the seleetmen for the pur- pose, shall upon application make the certificate required of the at- ending physician. If death is caused hy violence, the medical exam- ner shall make such certificate. If such a permit for the removal of 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 ahove provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal ; provided, that such hody 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 hody has been sooner ohtained 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 shail 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 elerk of the town for registration. The person to whom the permit is 30 given and the physician certifying the cause of death shall thereafter fur- nish for registration any other necessary information which can be ohtained 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) Beard of Health physiclans will certify to such deaths only as those of persons who, though disahled by recognized disease un- related to any form of injury, have died without recent medical attendance or whose physician is ahsent 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 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 he 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 hy the appropriate terms. as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.


SPACE FOR ADDITIONAL INFORMATION


MR-301 A


1


Iinthron


(City or Town)


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 ite Agent. 230


Winthrop Community Hospital No. ......


St.


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)


2 FULL NAME


ManyFitzgibbons .Thomas


(If deceased is a married, widowed or divorced woman, give also maiden name.)


(a) Residence. No ..


86 Hermon St


St


(If nonresident, give city or town and state)


(Usual place of abode)


Length of stay: In hospital or institution Hospital


(Specify whether)


years


months 2


days.


In this community


yrs.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


4 COLOR OR RACE


White


5 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED idowed


(Month)


(Day)


(Year)


19


I HEREBY CERTIFY.


4/16


19.60, to


12/21


1960


I last saw h ........... alive on


12/21


19 .. " .... , death is said to


have occurred on the date stated above, at. Immediate cause of death


Duration


IMPORTANT


Due to.


Due to.


Other conditions Me When Se (Include pregnancy within 3 months of death)


24-5


IMPORTANT


PHYSICIAN Underline the cause to which death should be charged sta- tlstically.


20 Was disease or injury in any way related to occupation of deceased ?.........


If so, specify.


(Signed). (Address)


......... Date ...


12/21


19,60


21. Winthrop


Winthrop


Place of Burial, Cremation or Remoyal. DATE OF BURIAL.


22 NAME OF FUNERAL DIRECTOR, ADDRESS


Received and filed.


19


(Registrar)


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-2-'40-D-729-a


17


Relation, if any Son


Informant (Address)


Tomas Harman St Dinttup


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:


wie D. Childress


(Signature Agent of Board of Health or other)


affien 12/22/40


(Date of Issue of Permit)


(Official I(signation)


18 DATE OF


DEATH ..


12


21


40


Female


Sa If married, widowed, or divorced


HUSBAND of.


(Glve maiden name of wife in full)


Frank Allen Thomas


(or) WIFE of


(Husband's name in full)


6 Age of husband or wife if alive.


.. years


7 IF STILLBORN, enter that fact here.


8


AGE5.8


Years


Months.


.Days


If less than 1 day Hours Minutes


9 Occupation :


Housewife


Industry


10 or Business:


Own Home


11 Social Security No.


12 BIRTHPLACE (City)


(State or country)


Ken.


PARENTS


14 BIRTHPLACE OF


FATHER (City)


Covington


(State or country) Kv


15 MAIDEN NAME


OF MOTHER


Cannot be learned


16 BIRTHPLACE OF MOTHER (City) ........ (State or country)


Cannot be learned


13 NAME OF


FATHER


Thomas


Fitzgibbons


Major findings: Of operations.


Date of.


Of autopsy.


What test confirmed diagnosis ?.


M. D.


(City OF Town)


/Winthrop


That I attended deceased from


Usual


Covington


PLACE OF DEATH


Suf folk


(County)


EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE


RETURN OF CERTIFICATES OF DEATH


A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness. at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, definded as required by section one, where saine was contracted, the duration of his last illness, when last seen alive hy the physician or officer and the date of his death . .. Gen. Laws, Chap. 46, Sec. 9.


No undertaker or other person shall hury or otherwise dispose of a human hody in a town, or remove therefrom a human hody which has not heen buried, until he has received a permit from the hoard of health, or its agent appointed to issue such permits, or if there is no such hoard, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human hody and remove it from a town, from one cemetery to another. or from one grave or tomh other than the receiv- ing tomh 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 hody is huried. No such permit shall be issued until there shall have been delivered to such hoard, agent or clerk, as the case may he, a satisfactory written statement containing the facts required hy law to he 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 physician, or if, for sufficient reasons, his certificate cannot he obtained early enough for the purpose, or is in- sufficient, a physician who is a member of the board of health, or em- ployed hy it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused hy violence, the medical examiner shall make such certificate. If such a permit for the removal of a human hody, not previously interred, from one town to another within the commonwealth cannot he obtained early enough for the purpose, the certificate of death made as ahove provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such hody shall he returned to the town from which it was removed within thirty-six hours after such removal, unless a perinit in the usual form for the re- moval of such hody has heen 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 furnish for registration any other necessary information which can be ohtained 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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