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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