USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1937 > Part 23
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12 BIRTHPLACE (City)
(State or country)
So Boston
Mass
18 NAME OF
FATHER
James J Dempsey
14 BIRTHPLACE OF
FATHER (City)
PARENTS
(State or country)
Middletown
Conn
15 MAIDEN NAME
OF MOTHER
Marion Murphy
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Maine
50m-9-'31. No. 3385-K
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
BOSTON (City or town making return)
Registered No.
1500
(If death occurred in a hospital or institution,
(If U. S.
War Veteran,
52
(Usual place of abode)
(write the word)
19
37 to.
Feb
8
Date of
--
I R-305
PLACE OF DEATH
SUFFOLK (County)
BOSTON (City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registered No.
1663
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
GEORGE ... W ...... BARKER
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No ...
23 ELMWOOD AY
.St., ..
Ward, WINTHROP
(If nonresident, give city or town and state)
(Usual place of abode)
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
3 SEX M
4 COLOR OR RACE
(write the word)
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
MARRIED
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
MARY V CAHILL
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 AGE 44 Years 5 Months 18 Days
If less than 1 day Hours . Minutes
OCCUPATION
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc. 9 Industry or business in which work was done, as silk mill, saw mill, bank, etc .....
PLASTERER
BUILDINGS
10 Date deceased last worked at this occupation (month and year)
1 -* 37
11 Total time (years) spent in this occupation. 24
12 BIRTHPLACE (City)
WINTHROP.
(State or country)
13 NAME OF FATHER WILLIAM W BARKER
PARENTS,
14 BIRTHPLACE OF
FATHER (City)
WASHINGTON
(State or country) D C
15 MAIDEN NAME OF MOTHER MARY E LARKIN
16 BIRTHPLACE OF MOTHER (City) (State or country)
CHARLESTOWN
25m-2-'30. No. 7997-0
17 Informast
(Address)
M. C BARKER (WIFE) 23 ELMWOOD AV WINTHROP
A TRUE COPY
ATTEST:
Heida Ofedition Quick
(Registrar of city or town where death occurred)
DATE FILED FEB 15 19 .. 37
MEDICAL CERTIFICATE OF DEATH
18 DATE OF DEATH F.E.B
10
1937
(Month)
(Day)
(Year)
19 | 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) CORROSIVE SUBLIMATE POISONING SELF-IN-
GES TED
PRESUMABLY SUICIDAL
20 If death was due to external causes (VIOLENCE) fill in the following : Accident, Suicide or Homicide ?
Date of injury.
19
Where did injury occur ? . WINTHROP
Manner of
Injury.
Nature of
Injury
21 Was disease or injury in any way related to occupation of deceased?
If so, specify.
(Signed)
W J
BRI CKLEY
M. D.
(Address)
BOSTON
Date
2 10 .19.37 .
22 PLACE OF BURIAL, CREMATION OR REMOVAL W.I.N.THROP (Cemetery)
WINTHROP
(City or town)
DATE OF BURIAL FEB 13
19 .. 37
23 NAME OF UNDERTAKER TRI BENNISON
ADDRESS
WINTHROP
Received and filed
19
(Registrar of City of Town where deceased resided)
1
No.
PSYCHOPATHIC HOSP
St.,
Ward
(If U. S.
War Veteran,
specify WAR)
53
(City or town and State)
R-302
tion should be carefully supplied. AGE should be stated EXACILY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very
important.
Som-9-'31. No. 338€-0
17 Laformant (Address)
T W MCLEAN (BROTHER)
155 COWPER ST E BOSTON
A TRUE COPY
ATTEST:
Heida Ofedition Quirks
(Registrar of city or town where death occurred)
DATE FILED FEB 18
19 37
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
FEB
14
1937
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from FEB 12
[ last saw h.
.I.M.alive on
F.EB.
14
19.3( ... , death is said
to have occurred on the date stated above, at. 2:47P m.
The principal cause of death and related causes of importance in order of onset were as follows: CARCINOMA OF RECTUM
Datapfonset 23 ... YR5
Contribatory causes of importance not related to principal cause:
COMB . .... ABCOMINAL PERINEAL RESECTION OF
RECTUM
6/4/35
Exc
METASTATIC
Name of operation
NODULE
Date of
1/26/37
What test confirmed diagnosis?
Was there an autopsy? No.
20 Was disease or injury in any way related to occupation of deceased? If so, specify.
(Signed)
A.
... G ...... ENGELBACH
M. D.
(Address)
MG H
Date
2 14.193.7.
21 PLACE OF BURIAL,
CREMATION OR RÉMOVAL
HOLY CROSS
(Cemetery)
FEE : 17
MALDEN
(City or town) 193.7
DATE OF BURIAL
22 NAME OF
UNDERTAKER
ADDRESS
C.H. TREANOR BOSTON
Received and filed
APR-21927 16
BOSTON (City or town making return)
Registered No
1847
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
HAROLD WILLIAM J MCLEAN
(If deceased is a married, widowed or divorced woman, give also maiden name.)
specify WAR)
(a)
Residence.
No ... 20 ... 1.RW.IN
.St.,.
Ward, WINTHROP
(If nonresident, give city or town and state)
(Usual place of abode)
Length of residence in city or town where death occurred
yrs.
mos.
days. How long in U. S., if of foreign birth?
yrs.
第08。 days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX M
4 COLOR OR RACE
W
5 SINGLE
(write the word)
MARRIED
WIDOWED
er DIVORCED
WIDOWED
5a If married, widowed, or divorced HUSBAND of EMMA.D ....... TERRIO (Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 AGE 56 .Years
Months Days
Minutes
OCCUPATIONİ
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc ...
PAINTER
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc.
HOUSE
10 Date deceased last worked at this occupation (month and year)
11-136
11 Total time (years) spent in this occupation. 30
12 BIRTHPLACE (City) (State or country) NEW BRUNSWICK
13 NAME OF
FATHER
WALTER L MCLEAN
PARENTS
14 BIRTHPLACE OF FATHER (City)
(State or country) NEW BRUNSWICK
15 MAIDEN NAME
OF MOTHER
CATHERINE TIMMINS
16 BIRTHPLACE OF MOTHER (City) (State or country) NEW BRUNSWICK
1
PLACE OF DEATH
SUFFOLK (County) BOSTON
(City or Town)
No. MASS ....... GENIL HOSP
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
St.,
Ward
(If U. S.
51
19
(Registrar of City or Town where deceased resided)
19.37 .. , to. FEB. 14. 19.3.7
If less than 1 day
.Hours.
R-302
PLACE OF DEATH
SUFFOLK (County) BOSTON
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
BOSTON (City or town making return)
Registered No.
2072
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
Helen C Babin
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No
145Main
.St.,.
Ward,
Winthrop, Mass
(Usual place of abode)
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
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
Widow
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Joseph Babin
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
AGE 42 Years Months
If less than 1 day
Hours
Minutes
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
Housework
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc.
At Home
10 Date deceased last worked at
this occupation (month and
11 Total time (years)
spent in this
occupation
12 BIRTHPLACE (City)
(State or country)
Nova Scotia
18 NAME OF
FATHER
Harry Currier
14 BIRTHPLACE OF
FATHER (City)
(State or country)
England
16 MAIDEN NAME
OF MOTHER
Maria Muise
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Nova Scotia
17
Informant
Joseph A Babin (Son)
(Address)
West Newton
A TRUE COPY.
Heida Ofeditions Quirks
ATTEST:
(Registrar of city or town where death occurred)
Feb 24, 1937
19 35
DATE FILED
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Feb
20 1937
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from Feb 10 1937 to Feb .20 , 19 37
I last saw h ..... elalive on
Feb.
2.0
19 37, death is said
to have occurred on the date stated above, at ....... 5.5 m.
The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonset
Bilateral lobar pneumonia 2/7/37
Contribatory causes of importance not related to principal cause: Diabetes Mellitus
1935
Name of operation
Date of.
What test confirmed diagnosis?
Was there an autopsy?Yes
20 Was disease or injury in any way related to occupation of deceased? If so, specify.
(Signed)
C A Powell
M. D.
(Address) Mass Memorial ... Hospate 2/20,19 .37
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Holy Cross-Malden
(Cemetery) (City or town) Feb. 23, 1937 19 35
DATE OF BURIAL . ........
22 NAME OF
UNDERTAKER
J J Kelley & Son
ADDRESS
336 Broadway, Cambridge
Received and filed
(.)
19 35
(Registrar of City or Town where deceased resided)
important.
50m-9-31. No. 3385.₪
1 3 SEX Female (or) WIFE of 7 OCCUPATIONI PARENTS I'DITE DLAINLY WUTTTY TINFATTINA -INY tion should be careruny supplied. ALE should be stated CAACILI. FRISICIANS snoula state CAUSE year) .. OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very
(City or Town) No. Mass Memorial Hospital
St.,
Ward
(If U. S.
War Veteran,
specify WAR)
55
(If nonresident, give city or town and state)
(write the word)
Days
-301
PLACE OF DEATH
Suffolk (County)
...
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No
50
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME.
Charles Thomas Seabury
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No
14 Pleasant Park Rd
.St., ..
Ward,
(If nonresident, give city or town and state)
(Usual place of abode)
Length of residence in city or town where death occurred 20
yrs.
mos.
days.
How long in U. S., if of foreign birth?
4 yrs.
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Widowed
5a Ii married, widowed, or divorced
HUSBAND of
Martha Jane Harvey
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 88
AGE
Years
11 Months 6 Days
If less than 1 day .Hours. .. Minutes
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc.
Boston Elevated R.
10 Date deceased last worked at
11 Total time (years)
this occupation (month and23 years
spent in this
45
year)
go
12 BIRTHPLACE (City)
Parkman
(State or country)
Maine
13 NAME OF
FATHER
Unable to obtain
PARENTS
14 BIRTHPLACE OF FATHER (City) .. (State or country)
Unable to obtain
15 MAIDEN NAME
OF MOTHER
Unable to obtain
16 BIRTHPLACE OF MOTHER (City) (State or country)
Unable to obtain
17 Informant (Address) 26 Emerson Ad.
Relation, if any s on
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the buril or transit permit was issued:
- (Signature of Agent of Board of Heart of other)
3/3/37
/(Official Designation)
(Date of Issue of Permit
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
3
(Day)
1
37 (Year)
19 I HEREBY CERTIFY, That I attended deceased from
I last saw h .. . Man.allve on
to have occurred on the date stated above, at m. The principal cause of death and related causes of importance in order of onset were as follows:
Date of Onset
R.
Contributory causes of importance not related to principal cause:
gener al Criterio
Name of operation.
What test confirmed diagnosis ?.
Date of
Was there an autopsy?
20 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed)
Hamis auf elly
(Address) tham
Date.
3 100
21 PLACE OF BURIAL.
CREMATION OR REMOVAL Winthrop
Winthrop
(Cemetery)
(City or town)
DATE OF BURIAL
March 3rd
1937
19
22 NAME OF
UNDERTAKER
Charles R. Bennison
ADDRESS Winthrop Mass
Received and filed 19
A TRUE COPY, ATTEST:
(Registrar)
100m-12-'34. No. 2938-6
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 OCCUPATION
1
Winthrop
No ...
(City or Town) 14 Pleasant Park Rd
St ........................ Ward
(If U. S.
War Veteran,
specify WAR)
(Month)
1937,
3 /
19.
19 ..?.... , death is said
Inspector (retired) lundi N'estet
, M. D.
Charles E. Seabury
occupation.
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 occupation prior to illness. If the deceased had retired from business, report the occupation prior to retirement. Children not gainfully employed may be returned as at school or et home. For a woman whose only occupation was that of home housework, write housework in answer to Question 8 and own home in answer to Question 9. 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 what- ever write none.
To be complete, an occupation return must state:
8 .- The trade, profession, or particular kind of work done.
9 .- The industry or business in which the work was done.
10 .- The month and year the deceased last worked at the occupation.
11 .- The number of years the deceased followed the occupation.
In stating the occupation, avoid the use of such indefinite terms as "employee," "worker,"""operative," etc. Find out the parti- cular kind of work done and return that, as spinner, weaver, etc.
In stating the industry or business, avoid the use of such general terms as "store." "factory,' mill," etc. State the particular kind of store, factory, mill, etc., as grocery store, soap factory, cotton mill, etc.
Distinguish carefully the different kinds of engineers by stating the full descriptive titles, as civil engineer, mechanical engineer, mining engineer, stationary engineer, etc. Avoid the term "laborer" when a more precise statement of the occupation can be secured. Do not use the word "mechanic, " but give the exact occupation, as carpenter, painter, machinist, etc. Distinguish carefully between retail merchanis and wholesale merchants. A person who sells goods should be called a salesman and not a clerk.
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 conditions, if any, related to the principal cause and any important complication of the principal cause. Under contributory causes of importance not related to principal cause, name other important diseases.
Example
The principal cause of death and related causes of importance in order of onset were as follows:
Date of onset
Arteriosclerosis
Chronic interstitial nephritis
1921
Cerebral hemorrhage
July 5, 1927
Contributory causes of importance not related to principal cause:
In a group of causes containing the principal cause and related causes, the causes should be given in the order of onset, so that in a group of three causes the principal cause may appear in either first, second, or third position. The principal cause in the above example happens to be the second cause given.
GO
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forth- with, 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 by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death .... Gen. Laws, Chap. 46, Sec. 9.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satis- factory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by 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 common- wealth cannot be 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 re- moval; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as re- quired by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require. - Chap. 114, Sec. 45, G. L., (Tercentenary Edition.)
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence .... Gen. 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; otherwise a description as full as may be, with the cause and manner of death .- Gen. Laws, Chap. 38, Sec. 7.
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 ceme- tery or burial ground in which the interment is made .. .. Chep. 114, Sec. 46, G. L., (Tercentenary Edition.)
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 un- related to any form of injury, have died without recent medical attend- ance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting 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, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
i R-301A
PLACE OF DEATH
(County)
Winthro
(City or Town)
160 Cottage Park Road
No.
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To Je filed for burial permit with Board of Health or its Agent.
Registered No.
5.2
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
William Henry Carrett
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No. 20. Cottage Park Road
(Usual place of abode)
Length of residence in city or town where death occurred
yrs.
days. How long in U. S., if of foreign birth?
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
ri te
5 SINGLE
MARRIED
WIDOWED
or DIVORCED Wido .or
5a If married, widowed, or divorced
HUSBAND of
Anna From Garrett
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here
7
AGE
Years
5
Months
8
Days
If less than 1 day Hours Minutes
OCCUPATION:
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
Sale sman
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc .. Electric Supplies
10 Date deceased last worked at this occupation (month and year)
19.32
11 Total time (years)
spent in this
occupation
50
12 BIRTHPLACE (City)
Lowell
(State or country) Massachusetts
13 NAME OF
FATHER
Henry L. Garrett
14 BIRTHPLACE OF
FATHER (City)
Lowell
(State or country) .Lass chusetts
15 MAIDEN NAME
OF MOTHER
Ella .. Dudley
16 BIRTHPLACE OF MOTHER (City) Lowe 11
(State or country) aBsachusetts
17
ielen L Bro mn
(Address)
356 E ... St Jex Haven Conn (France )
I HEREBY CERTI" { that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit, was issued; Was A Culdress Sigoature of Agent of Board of Health ofthely
Healthe Scherer 3/4/34
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
(Month)
1
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
{ last saw hA alive on
mari
1938.
... m.
death is said
to have occurred on the date stated above, atS. The principal cause of death and related causes of importance in order of onset were as follows:
Date of Onset IMPORTANT
1928
Chronic myocarditis
1932
Contributory causes of importance not related to principal cause:
Name
Name of operation.
What test confirmed diagnosis? a linea
Date of.
Was there an autopsy?
NO
20 Was disease or injury in any way related to occupation of deceased?
If so, specify
ty Gardien Dickinson
(Signed)
(Address faustino/ mass
M. D. Daten$ 4,192.
21 PLACE OF BURIAL
CREMATION OR REMOVAL
Lowell Cem Lowell Ma88
(Cemetery)
(City or town)
DATE OF BURIAL
March 4th 1837
19
22 NAME OF
UNDERTAKER
147 Winthrop St
Wirthis.
ADDRESS
Received and filed.
MAR 1 193/
19
(Registrar)
1
De careruny supplied. AGE should be stated LAACILI. 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 PLAINLY, WITH LINFANING RY AT
A R _WRITE
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