USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1941 > Part 41
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FATHER (City)
Dorset Co.
...
15 MAIDEN NAME
OF MOTHER
Alvenia Susan Bent
18 BIRTHPLACE OF
Bentville
PARENTS
MOTHER (City)
(State or country)
17
Hospital records
Informant.
(Address)
50r-10-'39. No. 8427-f
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
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
(State or country)
England
4 COLOR OR RACE 5 SINGLE
MARRIED
WIDOWED
or DIVORCED
single
(write the word)
6 Age of husband or wife if alive.
.Years
If less than 1 day
Hours.
Minutes
12 BIRTHPLACE (City)
(State or country)
Nova Scotia
Nova Scotia
Relation, if any
A TRUE COPY
Py Wunderof a. M Paraly
ATTEST:
(Registrar ofcity or town where death occurred)
DATE FILED
July
11
41
19
(1! U. S.
War Veteran,
specify WAR)
Winthrop, !!!
Mass.
St.
11
19.
41
should be charged sta- tistically.
JUL 141341 1
FORM R-301
MARGIN RESERVED FOR BINDING
Winthrop
(County)
1
Suffolk
(City or Town)
No ..
PLACE OF DEATH
2 FULL NAME
John Joseph Dervan
(a) Residence.
No.
75 Crest Ave
(Usual place of abode)
Length of stay: In hospital or institution
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
or DIVORCED Married
White
Male
5a If married, widowed? os divorced
Rafferty
HUSBAND of
(Give maiden name of wife in full)
6 Age of husband or wife if alive.
72
7 IF STILLBORN, enter that fact here.
AGE
Years
Months
Days
8
74
If less than 1 day
Usual
9 Occupation:
Retired
11 Social Security No.
12 BIRTHPLACE (City)
Boston
(State or country)
Massachusetts
13 NAME OF
FATHER
John J. Dervan
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
15 MAIDEN NAME
. OF MOTHER
Maria Rohan
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
17
Ellen A. Dervan
Informant.
(Address)
75 Crest Ave
Winthrop
Www. D. Children
information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
10 or Business:
(or) WIFE of.
(Husband's name in full)
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of
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
Tubing Manufacturer
200m-10-'39. No. 8427-đ
(write the word)
Relationę if any
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial ør transit permit was issued:
Signature of Agent of Board of Health or other) Health affecte 4/14/4 7 (Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
July
12
1941
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY. That I) attended deceased from
Joly 8
5
124/, to ...
2014
12
19.4 ...
I last saw h./ ....... 1 .. alive on ....
12
1941
.. , death is said
to have occurred on the date stated above,
9.8.
.. m.
years Immediate cause of death ...
... ...
.....
Carcinoma
of Prostate Gard
5 Mas.
Due to
Due to
Other conditions
(Include pregnancy within 3 months of death)
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 ?
No
If so, specify ..
Edward . Frange.
M. D.
(Signed)
(Address)
200 Wasbyugton Are Dato, lydb/ 19/
21
Place of Burial, Cremation or Removal.
DATE OF BURIAL
O JALy 15 9547
22 NAME OF
pour T- OMalen
ADDRESS
Winthrop Massachusetts
Received and filed ....
19.
A TRUE COPY ATTEST: (Registrar)
...
Date of.
Of autopsy
..
What test confirmed diagnosis ?
0
19
FUNERAL DIRECTOR
1
(If death occurred in a hospital or institution,
Winthrop Community Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No ..
St. { give its NAME instead of street and number) n (If U. S. War Veteran. specify WAR)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
.St.
(If nonresident, give gity or town and state)
years
months
1
days.
In this community
yrs.
mos.
days.
Duration
Hours ...........
.Minutes
Major findings :
Of operations
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS
GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hoaplial medical officer shall forthwith, after the death of a person whom he bas 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 hy 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 bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been huried, until he has received a permit from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died ; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomh 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 huried. 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 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 be obtained early enough for the purpose, or is insufficient, a physician who is a member of the hoard 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 hy violence, the medical exam- iner shall make such certificate. If such a permlt for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as ahove provided and in the possession of the undertaker desiring to make such a 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 ohtaincd hereunder. If the death certificate contains a recital. as required hy section ten of chapter forty-six. that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter fur- nish for registration any other necessary information which can be
ohtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Seo. 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 huried 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 ohserv- ance of the following rules of practice :
(1) Allending 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 lloalıh physicians will certify to such deaths only as those of persons who, though disabled hy recognized disease un- related to any form of injury, have died without recent medical attendance or whose physician is 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. hut also deaths from disease resulting from injury or infection relaled 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 morhid con- ditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupallon .- 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 husi- 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 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
RM R-303A
MARGIN RESERVED FOR BINDING
1
Winthrop
(City or Town)
No. 229 Main St
(a) Residence. No.
(Usual place of abode)
3 SEX
Female
4 COLOR OR RACE
White
Sa If married, widowed, or divorced
HUSBAND of.
(or) WIFE of.
6 Age of husband or wife if alive
7 IF STILLBORN. enter that fact here.
8
37 Years
10Months ......... Days
AGE
Usual
9 Occupation :.
At home
Industry
10 or Business:
11 Social Security No.
12 BIRTHPLACE (City)
Somerville
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Scotland
PARENTS
16 BIRTHPLACE OF
MOTHER (City) ..
(State or country)
Scotland
17
Paul B. Dinkel
DEATH in plain terms, so that it may be properly classified under the International Classification of Causes
information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of
of Death. See reverse side for extracts from the laws relative to the return of certificates of death.
(State or country)
Massachusetts
25m-2-'40-D-729-b
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Www.D. Children
(Signature of Agent of Board of Health or other )
7/14/41
(Officlal Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
Jah-12 -1941
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows; (If an injury was involved, state fully.) Barbiturates Preming
Carcinoma Left Breast
20 Accident, suicide or homicide (specify)
Presumetts Suicidal
Date of occurrence.
July-12 -
19.44.1.
Where did
Injury occur?
Hatten
(City or Town and State)
Did injury occur in or about home, on farm, in industrial place, in public place?
(Specify type of plage)
Injury
Found dead in her bed
Manner of
Nature of
Injury
While at work ?.
000
Was there an autopsy ?...
21 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed)
(Address)
Better
Polo - 12-
19.5./.
22 .. Shawsheen Cemetery Bedford Mass Place of Burial, Cremation or_Removal
(City or Town)
DATE OF BURIAL
July 15.
1941
19
23 NAME OF
FUNERAL DIRECTORCharles R. Bennison
ADDRESS
Winthrop Mass
Received and filed
19
(Registrar)
125
Registered No.
§ (If death occurred In a hospital or institution. ¿ give its NAME instead of street and number)
2 FULL NAME.
Marion Isabelle
(cameron)
Dinkel
(If deceased is a married, widowed or divorced woman, give also maiden name.)
229 haen St Winthrop
St
(If nonresident, give city or town and state)
Length of stay: In hospital or institution. (Specify whether)
years
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
(Give maiden name of wife in full)
Faul B. Dinkel
(Husband's name in full)
42 years
years
If less than 1 day .Hours ..... .. Minutes
13 NAME OF
FATHER
Alexander Cameron
15 MAIDEN NAME
OF MOTHER
Isabelle Angus
Relation, if any husband
Informant (Address) 229 Main St Winthrop Mass
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
PLACE OF DEATH
SalleCk . KCounty)
St.
(If U. S.
War Veteran,
specify WAR)
M. D.
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, defined as required hy section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death . . . Gen. Laws, Chap. 46, Sec. 9.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been 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 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 body Is buried. No such permit shall he issued until there shall have heen delivered to such board, agent or clerk. as the case may be, a satisfactory written statement containing the facts required by law to he returned and recorded, which shall he 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 body, 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 above 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 re- moval of such body has been sooner ohtained 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 he 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 of the asnes thereof which have been hrought 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 hoard, from the clerk of the town where the body Is to he huried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burlal ground In which the Interment is made. . . . Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died hy violence. If a medical examiner has notice that there is within his county the body of such a person, he shall forthwith go to the place where the hody lies and take charge of the same; . . . - General Laws, Chap. 38, Sec. 6.
... He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; other- wise a description as full as may be, with the cause and manner of death. -General Laws, Chap. 38, Sec. 7.
. The medical examiner certifies the cause and manner of death to the best of his knowledge and belief.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance 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 illness 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 unrelated 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 hy traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, hut also deaths from disease resulting from injury or Infectlon related to occupation, the sudden deaths of persons not disahled hy recognized disease, and those of persons found dead.
STATEMENT OF CAUSE OF DEATH
Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify: (1) Under cause, the nature of an injury and of its consequences; and (2) under manner, the mode of its production together with the circumstances when these are known. For example: "Compound fracture of the femur with ensuing septicemia (gas hacillus) caused hy a steam railway accident." "Pistol shot wound of the chest with associated hemorrhage, homicidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether administered as a surgical anaesthetic." "Fracture of the skull with asso- ciated internal injury sustained under circumstances unknown."
If disease or injury was related to occupation, specify. If investigation shows the death to have been due to disease, specify: (1) Under cause its known or presumable nature; and (2) under manner, indicate the cir- cumstances leading to medico-legal inquiry. For example: "Hemorrhage spontaneous, of the hrain (basal ganglia) (found dead in hed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)"
DESCRIPTION (for unknown person)
NOTICE TO UNDERTAKERS: No embalming fluid, or any substitute therefor, shall be injected into the body of any person supposed to have met his death by violence, until a permit, signed by the Medical Examiner, has first been obtained .- General Laws, Chap. 38, Sec. 14.
THIS CERTIFICATE CONSTITUTES SUCH PERMIT
RM R-301 A
PLACE OF DEATH
Suffolk (County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No.
128
§ (If death occurred in a hospital or institution, ¿ give its NAME instead of street and number)
2 FULL NAME
Nellie ( Floyd ) Griffin
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
19 Sargent ... St ...
....
St
(If nonresident, give city or town and state)
In this community ( O)
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Widow
(Give maiden name of wife in full)
(or) WIFE of
Sidney Ernest Griffin
(Husband's name in full)
6 Age of husband or wife if alive. .years
7 IF STILLBORN, enter that fact here.
8
70
Years
D ... Months.
9 ... Days
If less than 1 day
Hours
Minutes
12 BIRTHPLACE (City)
(State or country)
Mass.
Philip Payson Floyd
FATHER (City)
Winthrop
(State or country)
Mass.
15 MAIDEN NAME
OF MOTHER
Abbie Allen
16 BIRTHPLACE OF
MOTHER (City)
Winthrop
(State or country) Mass.
Relation, if any
17
Sidney Griffin
(
(Address) 131 N Main St. Lombard ILL.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: William D. Children
(Signature of Agent of Board of Health or other)
agent
July 17/41
(Official Designation) (Date of Issue of Fermiz)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
July
17
1941
(Month)
(Y'ear)
19
I HEREBY CERTIFY,
7/16
19.41, to.
........
7/17
19 41
I last saw he alive on
7/16
19 .. 5/ .. /, death is said to
have occurred on the date stated above, at.
L.F.m.
Immediate cause of death ..
٢٥
auguina
Due to. Pertorie
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 ?.
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.
Hours, auf elly
(Signed)
M. D.
(Address)
21.
Winthrop
Winthrop
Place of Burial, Cremation or Removal.
(City or Town)
GT
19.
41
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
Received and filed.
19
(Registrar)
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of
Winthrop
1
(City or Town)
3 SEX
Female
5a If married, widowed, or divorced
HUSBAND of
AGE ..
Usual
9 Occupation :
Housewife
10 or Business:
11 Social Security No.
None
13 NAME OF
FATHER
14 BIRTHPLACE OF
PARENTS
Informant
information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
is very important. See instructions and extracts from the laws on back of certificate.
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION
Industry
Own Home
100m-2-'40-D-729-8
No. 19 Sargent St.
St.
(If U. S.
War Veteran,
specify WAR)
(Usual place of abodc)
Length of stay: In hospital or institution.
(Specify whether)
years
months
days.
(Day)
That I attended deceased from
Duration IMPORTANT
10 km
DATE OF BURIAL
July
Date ...
7/17
.19 .. 44/
Winthrop
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 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.
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