Town of Winthrop : Record of Deaths 1939, Part 106

Author: Winthrop (Mass.)
Publication date: 1939
Publisher:
Number of Pages: 560


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1939 > Part 106


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5 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word)


Singlo


5a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


If less than 1 day


Hours


Minutes


11 Total time (years)


spent in this


occupation.


Relation, i (


(Registrar of city or town where death occurred)


DATE FILED 19


Vary L Cawthorno


St., .........


........


Ward


(If U. S. War Veteran,


WAR)


(If nonresident, give city or town and state)


yrs.


mos.


Dec 6/39


WE.CEIVL


OF 10!


1


12


1


5


5


8


1


6


HROP MASS


FEB-51940 AM


M R-302


1 3 SEX F (or) WIFE of 7 56 AGE 12 BIRTHPLACE (City) (State or country) 14 BIRTHPLACE OF FATHER (City) PARENTS 17 A TRUE COPY. ATTEST: tion should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very OCCUPATION important. 50m-11-'36. No. 9080-g N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of informa- (State or country)


PLACE OF DEATH


(County)


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH


269


(City or town making return)


Registered No


10742


(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


Flora Mabel Gilpatrick


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


(a)


Residence. No.


(Usual place of abode)


9141 Shirley


St.,


........


Ward,


Winthrop


(If nonresident, give city or town and state)


Length of residence in city or town where death occurred


yrs.


mos.


days .


How long in U. S., if of foreign birth?


yrs.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


December 19 1939.


(Month)


(Day)


(Year)


5a If married, widowed, or divorced


HUSBAND of


(Give ma


Jothar F Gifpatrick


(Husband's name in full)


6 IF STILLBORN, enter that fact here.


Years Months Days


If lass than 1 day Hours . Minutes


8 Trade, profession, or particular


kind of work done, as spinner,


sawyer, bookkeeper, etc ...


At Home


9 Industry or business In which


work was dona, as silk mill,


saw mill, bank, etc.


Housewife


10 Date deceased last worked at


11 Total time (years)


this occupation (month and


spent in this


12/39


occupation


year).


25


Waltham


Mass.


13 NAME OF


FATHER


Charles F. Chase


Bridgeton,


Maine


15 MAIDEN NAME


OF MOTHER


Mary E. Lemp


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


England


Relation, if any


Informant


( Address)


9142 Shirley St. Winthrop


(Registrar of city or town where death occurred)


DATE FILED 19


19 I HEREBY CERTIFY, That I attendad deceased from


We


12/9


19.3.9, to


12/19


19.3.9


I Tast saw h.e.K ..... alive on


12/19


19.3.9 .. , death is said


to have occurred on tha data stated above, at. 5:28 m. P.M.


Tha principal cause of death and related causas of importance in order of onset were as follows:


Dateofonset


Carcinoma of bladder


Broncho pneumonia


(b11)


Mo.s.


ds


Contributory causes of importance not related to principal cause:


Supra pubic cystotomy with Nama of operationpart. exc. of carcinate of 12/13/39 What test confirmed diagnosis? Was there an autopsy ?..... e.8


20 Was diseasa or injury in any way related to occupation of deceased? If so, specify.


(Signed)


W. B. Osgood


M. D.


(Address)


Peter B. Brigham H Data 12/20939


21


Mt. Feake


Waltham


Place of Burial, Cremation or Removal.


(City or Town)


DATE OF BURIAL


Dec. 22, 1939.


19


22 NAME OF


UNDERTAKER


R. C. Kirby


ADDRESS


East Boston


Received and filed


Dec. 26, 1939.


19


(Registrar of City or Town where deceased resided)


4 COLOR OR RACE


W


(write the word)


5 SINGLE


MARRIED


WIDOWED


or DIVORCED


Married


e of wife in full)


(City or Town)


No.


Peter Bent Brigham Hosp. St.,


.....


..... .Ward


Husband


MI TO


7


S


6


B-31940 MM


R-302


1 No. 3 SEX M (or) WIFE of 7 AGE 63 OCCUPATION (State or country) 13 NAME OF FATHER 14 BIRTHPLACE OF FATHER (City) 16 BIRTHPLACE OF PARENTS MOTHER (City) (State or country) 17 ( Address) A TRUE COPY. important. tion should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very 50m-11-'36. No. 9080-g A. D. WERIC FLAIRLT, WITH UNTADING INATITIDD DD A PERMANENT RECORD. Every Item of informa- (State or country)


PLACE OF DEATH


(County) Boston


(City or Town)


Mass. General Hosp.


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH


ROE


(City or town making return)


Registered No.


10948


(If death occurred in a hospital or institution,


give its NAME instead of street and number)


2 FULL NAME


John W. Pepper


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


(a) Residence. No.


(Usual place of abode)


137 Loring Road


.St., ..


Ward,


Winthrop


(If nonresident, give city or town and state)


Length of residence in city or town where death occurred


yrs.


mos.


days. How long in U. S., if of foreign birth?


yrs.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


(Month)


(Day)


(Year)


19 I HEREBY


CERTIFY, That ] attended deceesed from


12/28/39


19


12/10/39


19.


... to ..


I last saw


1m


alive on


12/28/39


19.


death Is said


9:40 m. A. M.


to have occurred on the date stated above, at. The principal cause of death and related causes of Importence in order of onset were es follows:


Dateofonset


Pulmonary infarction


3 .... wks.


Contributory causes of importance not related to principal cause:


Pulmonaryembolism


10.


.. min ..


Name of operation


Date of


What test confirmed diagnosis?


Was there an autopsy?Y.e.s


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


If so, specify.


(Signed)


N. C. Baker


M. D.


(Address)


Ass t. Director Data 2/28 19 39


21


Woodlawn-Everett


Place of Burial, Cremation or Removal.


(City or Town)


Relation, if any


DATE OF BURIAL


Dec. 30, 1939


19


22 NAME OF


A. E. Long & Son, Inc.


UNDERTAKER


ADDRESS


1979 Mass. Ave., Cambridge.


Received and filed


Jan. 2, 1940.


19


(Registrar of City or Town where deceased resided)


Informant


Raymond T. Sewall (None


232 Bay State Rd.


Boston


ATTEST:


James Q. Burke


(Registrar of city or town where death occurred)


DATE FILED .19.


(write the word)


18 DATE OF


DEATH


December 28, 1939.


5a If married, widowed, or divorced HUSBAND of


Alma G. Forristall


(Give maiden name of wife in full)


(Husband's name in full)


6 IF STILLBORN, enter that fact here.


4


Years


Months 25


Days


If less than 1 day


Hours


.Minutes


8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.


Factory Manager


9 Industry or business In which


work was done, as silk mill,


saw mill, bank, etc ..


Franklin Calk Co.


10 Date deceesed last worked at


this occupation (month and


year)


1929


11 Total time (years)


spent in this


occupation


25


12 BIRTHPLACE (City)


Chelsea


Mass,


Pepper


16 MAIDEN NAME


OF MOTHER


Sarah W.


St.,


Ward


(If U. S.


War Veteran,


specify WAR)


4 COLOR OR RACE


W


5 SINGLE


MARRIED


WIDOWED


or DIVORCED


Widowed


TO


198


5


6


MASS


HROP


FEB-51940 AN


R-302


1


PLACE OF DEATH


Middlesex


(County)


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


Lexington (City or town making return)


Registered No.


111


(If death occurred in a hospital or institution, S


St. (


give its NAME instead of street and number)


2 FULL NAME


Peter Barclay


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


170 Pauline


St.


Winthrop, Mass.


(a) Residence. No ....


(Usual place of abode)


Length of stay: In hospital or institution ..


(Specify whether)


5


29


months


days.


In this community


yrs.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX Male


4 COLOR OR RACE 5 SINGLE


White


(write the word)


MARRIED


WIDOWED


or DIVORCED


Single


5a If married, widowed, or divorced HUSBAND of (Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


years


6 Age of husband or wife if alive.


7 IF STILLBORN, enter that fact here.


8


59


Years ..


11


Months .. 4 ...


... Days


If less than 1 day


Hours.


Minutes


Usual


Painter


9 Occupation:


Industry


Last worked: About 1928


10 or Business:


......


11 Social Security No ..... Boston


12 BIRTHPLACE (City)


(State or country)


Mass.


13 NAME OF


FATHER


Peter Barclay


14 BIRTHPLACE OF


Cannot learn


PARENTS


FATHER (City)


(State or country)


Scotland


15 MAIDEN NAME


OF MOTHER


Margaret Trotter


16 BIRTHPLACE OF


Cannot learn


MOTHER (City)


(State or country)


Scotland


"Metropolitan State Hosp. Records) Informat (Address) Waltham, Massachusetts


A TRUE COPY.


James. I Carroll.


ATTEST:


(Registrar of city or town where death occurred)


DATE FILED Dec. 26,


19


39


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


December 24, 1939


(Month)


(Day)


(Year)


19


LHEREBY CERTIFY.


October 14.


1958


.. ,


That I attended deceased from


to.


December 24.


,19. 39


I last saw h .. im


alive on.


December 24, 39


death is said


to have occurred on the date stated above, at


7:16 P


m.


Duration


Immediate cause of death ....


Cirrhosis of Liver


10 yr's


Due to


Due to


Other conditions


(Include pregnancy within 3 months of death)


PHYSICIAN


Major findings :


Of operations


Date of.


Of autopsy


yes


Clinico-path@stically.


20 Was disease or Injury In any way related to occupation of deceased ?


If so, specify


(Signed)


Emeridf Friedman


M. D.


(Address)Met. State Hosp .... Date12/24639


21 PLACE OF BURIAL, aftham


CREMATION OR REMOVALWinthrop ..


(Cemetery) lass


Com.


Winthrop


DATE OF BURIAL


12/27/189


22 NAME OF


FUNERAL DIRECTOR


Charles R. Bennison


ADDRESS


170 Winthrop St .Winthrop Mass


Received and filed


19


(Registrar of City or Town where deccased resided)


50m-10-'39. No. 8427-f


of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)


Lexington Medical and Surgical Bldg. M&S] No .... Metropolitan ... State .... Hospital


(If U. S.


War Veteran,


268


specify WAR)


(If nonresident, give city or town and state)


years


Relation, if any


(Chy or Town)


Underline the cause to which death should be charged sta-


What test confirmed diagnosis?


.Logical


no


RECEIVED


OFFICE


LUM


GLERK


-5


IP MASS


MAY201940 Ml





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