USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 34
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(3) Medical Examiners will investigate and certify to all deaths sup- posahly due to injury. These include not only deaths caused directly or in- directly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deatlis following abortion, but also deaths from disease resulting from Injury or Infection related to occupation, the sudden deaths of persons not disabled hy recognized disease, and those of persons found dead.
STATEMENT OF CAUSE OF DEATII
Medical Examiners in certifying to a death will state the cauae 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 : "Coin- pound fracture of tlte femur with ensuing septicemia (gas bacillus) caused by a steamtt railway accident." "Pistol shot wound of the chest with asso- ciated hemorrhage, homicidal." "Asphyxiation by suspension, suicidal." "Syncope while under the intluence of ether administered as a surgical anaesthetic." "Fracture of the skull with associated internal injury sus- tained 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 ita known or presumable nature; and (2) under manner, indicate the circum- stances leading to medico-legal inquiry. For example : "Ilemorrhage spon- taneous of the brain (basal ganglia) (found dead in bed)." "lleart 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
-302
Suffolk
(County)
Chelsea
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
City of town making return)
93
Registered No.
232
No. "Soldiers Home Hospital
2 FULL NAME
Raymond A. Knapp
(If deceased is a married, widowed or divorced woman, give also maiden namc.)
(a) Residenoe. No.
5 Irwin St.
St.
Winthrop,
MASS.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay : In hospital or Institution ......
Hospital
years
months
In this community
yrs.
mos.
days.
(Before death)
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
marri
5a If married, widowed, or divorced
HUSBAND of
Ellen Cooper
(Give maiden 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.
8
AGE
5mars.
EMonths ...... 1.7 Days
If less than 1 day Hours. Minutes
Usual
9 Oooupation :
CivilEngineer
Industry 10 or Business :
11 Social Security No ....
none
12 BIRTHPLACE (City)
(State or country)
Newburyport
Other conditions.
(Include pregnancy within 3 months of death)
Major findings :
Of operations
abscess of abdominal
wall
Date of
3/30/43
Of autopsy
Phys. Exam. &
What test popfl mododiagnostyh.
20 Was disease or injury in any way related to oooupation of deopergd ?.
If so, speolfy
(Signed) .Louis .... I ...... Rudiger
M. D.
(Address) Gold .... Homo .... Cho.lse pate ...
4/29 43
21 PLACE OF BURIAL,
CREMATION OR REMOVAAKGrove Com. , Gloucester
DATE OF BURIAL
Cemetery)5, 1943
City or Town)
19
22 NAME OF
FUNERAL DIRECTOR
Albert Douglas
ADDRESS
ash. Av., Chelsea
Reoelved and filed
MAY -1-3 1943
19
(Registrar of City or Town where deceased resided)
50m (e)-1-41-4667
A TRUE COPY.
ATTEST :
DATE FILEO
(Registrar of city or town where Cada th Yoccurred) rk Apr. 2, 19 43
18 DATE OF
DEATH
(Month) 2, 10(bis)
(Year)
19 | HEREBY CERTIFY,
That I attended deceased from
I last saw h
j+alive on
Apr.
,
45
to ..... A.s.r ........
19
death Is sald to
have occurred on the date stated above, at ...
.m.
Duration
Immediate oause of death. Carcinoma .... of .... bladder
about
Chronic cystitis c
formation 2 yrs
Due to.
of calcium deposits
Due to.
abscess of abdominal
1 .... weck
Physician Underline the cause to which death should be charged sta- tistically.
PARENTS
14 BIRTHPLACE OF
FATHER (City)
Laine
(State or country)
15 MAIDEN NAME
OF MOTHER
l'aribel Clarke
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Now Ham shire
17
Informant.
(Address)
Hospital Records, Relation, if any
Josephe Le Dyrsee
1
PLACE OF DEATH
(C'ity or Town)
(If death occurred in a hospital or institution, St. give its NAME instead of street and number)
(If U. S.
War Veteran,
specify WAR)
World
male
white
13 NAME OF
FATHER
Carroll 3. Knapp
Wall
-302
1
PLACE OF DEATH
Suffolk (County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Chelsea (City or town making return) 94
Registered No.
240
No. .Soldiers ....... Homo Hospital
2 FULL NAME
Miles Dauley
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residenoe. No.
24 Hawthorne Av.
........
St.
Winthrop, Masswar I
(Usual place of abode)
Length of stay: In hospital or Institution ....
hospital
years
months
days.
In this community
yrs.
mos.
days.
(Before death)
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
marrida
5a If married, widowed, or divorced
HUSBAND of
Elizabeth ... Sullivan
(Give maiden 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 faot here.
8
AGE
54 Years.
CMonths
1.9ay
If less than 1 day Hours. .Minutes
Usual
9 Occupation:
Plumber
Industry 10 or Business :
11 Social Security No .....
unknown
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
FATHER
Miles Dauley
14 BIRTHPLACE OF
East Worcester
FATHER (City)
(State or country)
New York
15 MAIDEN NAME
OF MOTHER
Lucinda Roce
East Worcester
NewYork
17 LOSP. , Records
Informant ... (Address)
Relation, If any "Sold. Home Hosp., .. (Chelsea ......- )
A TRUE COPY.
ATTEST :
Seraple & Spencer
( Registrar of city or town where yat Courants
DATE FILED Apr. 5, 1943
22 NAME OF
FUNERAL DIRECTOR Chas ....... R ........ Bennison ..
ADDRESS 1.7.0 .... Winthrop .... St .......... inthrop
Reoelved and filed
MAY 1 3 1943
19
(Registrar of City or Town where deceased resided)
:
(Signed)
Manfred Kydan
M. D.
(Address) .Sold ... Homo ... Che.l.s.e@Pat ....... 4 ... 5.19 ....... 43
21 "PLACE OF BURIAL,
CREMATION OR REMOVAL / inthrop Cem. Winthrop
(Cemetery)
Apr. 7. 19439
Town)
DATE OF BURIAL
Physician
Major findings :
Of operations.
Date of
should be
charged sta-
Of autopsy
What test confirmed diagnosis ?. Clinicalxray 20 Was disease or Injury In any way related to oooupation of deceased ?.. NO .. If so, speolfy.
tistically.
PARENTS
50m (e)-1-41-4667
19
HEREBY CERTIFY,
That I attended deoeased from
19 ..... 4.3
to .......
APT
43
...
19.^
I last saw h
alixe on
"Apr: 5;
death Is sald to
.m.
Duration
Immediate cause of death
left lobar pneumonia
12-das
right bronchopneumonia
Due to.
Due to.
Other conditions
(Include pregnancy within 3 months of death)
Underline the cause to which death
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Chelsea
(City or Town)
( If death occurred in a hospital or institution,
St.
give its NAME instead of street and number)
(If U. S.
War Veteran,
specify WAR)
World
.......
(If nonresident, give city or town and State)
male
white
18 DATE OF
DEATH
Ami1-5, 1965
(Year)
have occurred on the date stated above, at.5 a.m.
R-302
Essex
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF
Danvers
(City or town making return) 95
Danvers CERTIFICATE OF DEATH Registered No. (City or Town) Danvers State Hospital, Hathorne, Mass (If death occurred in a hospital or institution, No.
Annie C. Meinhardt (Beattie)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residenoe. No.
57 Townsend
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution
(Before death)
(Specify whether)
years 4
months
2
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
female
4 COLOR OR RACE!
white
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
wid.
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
Char Kov maidenineme af wife(in full)
(Hushand's name in full)
6 Age of husband or wife If alive
years
7 IF STILLBORN, enter that fact here.
8 AGE 92
Years.
..... Months.
.Days
If less than 1 day Hours .Minutes
Usual
9 Oooupation :
at home
Industry 10 or Business :
11 Social Security No.
no.n.e.
12 BIRTHPLACE (City)
London
(State or country)
England
13 NAME OF
FATHER
David H. Beattie
14 BIRTHPLACE OF
FATHER (City)
(State or country)
England
15 MAIDEN NAME
OF MOTHER
Annie Wardrobe
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Scotland
17 Mary K. McPhillips
Relation, if any
Informant.
(Address HHathorne Mass,
A TRUE COPY.
ATTEST :
at restations
(Registrar of city or town where death occurred)
DATE FILED
....
April 20
19
43
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
April
14
1943
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
Dec . 12
1942
That. L attended deceased from
to
April
14
1943
I last saw h ............ allve on.A.p.r.i.l
1.4
19 ... 43death Is sald to
have oocurred on the date stated above, at.
7:40 p.
.. m.
Duration
Immediate cause of death
Chronic Myocarditis
1 vr.
Generalized arteriosclerosis
15 yrs.
Due to.
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
Physician
Major findings :
Of operations
Date of
should be
charged sta- tistically.
Of autopsy
What test confirmed diagnosis? clinical
20 Was disease or injury In any way related to oooupation of deceased ?.
If so, specify.
(Signed)
Leo Maletz
M. D.
(Address) Hathorne ....... Mass .....
Date 1/169 13
21 PLACE OF BURIAL, WOOuLawn Cemetery,
CREMATION OR REMOVALEverett Mass".
(Cemetery
DATE OF BURIAL
Anr Cemetery,
(City or Town),
1943
22 NAME OF
FUNERAL DIRECTOR
John T. White
ADDRESS
Boston, Mass
Reoelved and filed
MAY 1 3 1943
19
(Registrar of City or Town where deceased resided)
50m (e)-1-41-4667
------- - - ut vitturan transmitted on Form -302 to the clerk
of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)
PARENTS
PLACE OF DEATH
(County)
1
give its NAME instead of street and number)
(If U. S.
war Veteran,
Warły WAR)
Winthrop,
Mass.
St.
Underline the cause to which death
12-302
Suffolk
PLACE OF DEATH
Chelsea
1
(('ity or Town) U.S. Naval Hospital
The Commonfocalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Chelsea
(City or town making return)
.270
Registered No.
( If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME (If deceased is a married, Mowedsomdiggjed ertmar wie also maiden name.)
St.
(If nonresident, give city]of town and State)
Length of stay : In hospital or Institution ..
(Before death)
(Specify whether)
years
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF APRIATE BO DEA5143
3 SEX
4 COLOR OR RACE
M
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married DEATH
(Month)
(Day)
(Year)
19 I HEREBY CURTARY ,
1m 19 ..
Apr ....
.20
i last saw h.
alive on
6
death Is sald to
have oocurred on the date stated above, at. Immediate ods@britannitis
m.
6 Age of husband or wife if allve years
7 IF STILLBORN, enter that fact here,
19
If less than 1 day Hours. Minutes
Usual
9 Occupation :
Variety .... Store
Industry 10 or Business :
11 Social Security No .. Boston , Mas.s ...
12 BIRTHPLACE (City)
(State or country)
Thomas
13 NAME OF
FATHER
Canada
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Mary E. Burke
15 MAIDEN NAME
OF MOTHER
Boston, Mass.
16 BIRTHPLACE OF MOTHER (City)
(State or coura Sarah Lane
wife
17
Informant
(Address)
172 Somerset Ay lWinthop
A TRUE COPY.
ATTEST :
(Registrar of city or town where death occurred)
DATE FILED
Apr .22.1943
19
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
Received and filed.
MAY 1 3 1949
19
(Registrar of City or Town where deceased resided)
tode
resided in another city or town at the time of death should be made formin PARENTS
50m (e)-1-41-4667
8
AGE Years Months Days
Propriet
Due to
Due to.
Other conditions
(Include pregnancy within 3 monthe gf
RuptoGastric ulcer
Physician
Underline the cause to
Major findings:
Of operations
Date binical
should be charged sta- tistically.
Of autopsy
What test confirmed diagnosis ?.
20 Was disease or injury in any way related to oocupation,
F. G. Balch , Comdr ( MC )V(S)
If so, specify
(Signed)
USNHosp.Chelsea
4/20
4:
M. D.
(Address) .... Winthrop ... Com.wirpathr.op., Ma.ss ...
21 PLACE OF BURIAL,
April 23,1943
CREMATION OR REMOVAL
(Cemetery)
White Funeral Home
(City or Town)
DATE OF BURIAL
147 Winthrop St. Winthrop
8.809 in thesalesk
No.
Henry J. Lane
St.
(If U. S. War Veteran,
World 1
Winthielfy, WARS.S.
(a) Residenoe. No.
(Usual place of abode)
1
5a If married, widowed, or diveBrah Macquarrie HUSBAND of
(or) WIFE of
(Give maiden name of wife in full)
(Husband's name in full)
18 DATE OF
APar P attended deceased
43
43
19
2.4 .... hr
50 6
Gastric ulcer, ruptured-
which death
R-302
Essex
(County )
Danvers (City or Town)
The Commonforalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF
CERTIFICATE OF DEATH
Registered No.
S (If death occurred in a hospital or institution, give its NAME instead of street and number) r
2 FULL NAME .. Marie A. Stokes (Graeser)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residenoe. No.
(Usual place of abode)
St.
Winthrop,
Mass.
(If nonresident, give city or town and State)
Length of stay : In hospital or Institution.
(Before death)
(Specify whether)
26 years 4 months 18 days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEDna rri ed
5a If married, widowed, or divoroed HUSBAND of
(or) WIFE of
Georgivs maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife if alivcannot ..... he .... learned years
7 IF STILLBORN, enter that fact here.
72
AGE Years. .Months .... .. Days
If less than 1 day Hours ... .Minutes
Usual
9 Occupation :
housewife
Industry 10 or Business :
11 Social Security No ...
none
12 BIRTHPLACE (City)
(State or country)
Germany
13 NAME OF
FATHER
Joseph Graeser
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
"Germany
15 MAIDEN NAME
OF MOTHER
Anna Jager
16 BIRTHPLACE OF
MOTHER (City)
(State or country) Germany
17 Mary K. McPhillips
Relation, If any
Informant
(Address) Ha thorne Class.
A TRUE COPY. ATTEST :
(Registrar of city or town where death occurred)
DATE FILED April 26
1943
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
April
22
1943
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY, Jan. 1
19.34
to
April 22
19
43
19
4death Is said to
have oocurred on the date stated above, at. 6:00 2. .m.
Duration
Immediate cause of death
Cerebral hemorrhage
4 days
Diabetes Mellitus
32 yrs
Due to
Due to.
Other conditions
(Include pregnancy within 3 months of death)
Physician
Underline the cause to
Major findings :
Of operations
Date of
should be charged sta-
tistically.
What test confirmed diagnosis ?
20 Was disease or Injury in any way related to occupation of deceased ?
If so, speolfy
Leo Maletz
M. D.
21 "PLACE OF BURIAL,
CREMATION OR REMOVAL ..
Mt.
Pleasant Cemetery Arlington, Mass.
DATE OF BURIAL
April 24
(Cemetery)
(City or Town)
19
43
22 NAME OF
L. Brooks Saville
FUNERAL DIRECTOR
ADDRESS
Arlington, Mass.
Received and filed MAY .1. 31913
19
(Registrar of City or Town where deceased resided)
of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)
50m (e)-1-41-4667
1
PLACE OF DEATH
Danvers State Hospital, Hathorne, Massi No.
Danvers
(City or town making return) 97
(If U. S.
War Veteran,
specify WAR)
female white
That. I. attended deceased from
I last saw h.
er
April
22
.alive on
which death
Of autopsy
clinical
(Signed)
(Address) Hathorne, Wass.
... Date.41.23.1.43
IR-302
Essex
The Commontoralth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF
Danvers
(City or town making return)
98
Registered No.
Danvers State Hospital, Hathorne, Masst (If death occurred in a hospital or institution, No.
give its NAME instead of street and number)
2 FULL NAME
Annie F. Murphy (Ring)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
104 Highland Avenue
St.
Winthrop, Mass.
(Usual place of abode)
Length of stay: In hospital or Institution
(Before death)
(Specify whether)
years
5
months
10 days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
April
28
1943
(Month)
(Day)
(Year)
19 | HEREBY
CERTIFY,
That . I. attended deceased from
Nov. 18
19
to ..
April 28
19.
43
I last sawher
alive on.
April 28
19.435, death Is sald to
have occurred on the date stated above, at ..................... m.
Duration
Immediate cause of death
Bronchopneumonia 2 wKs.
Chronic Myocarditis
5 yrs.
AGE ... 88 ... Years.
.Months
Days
If less than 1 day
Hours ....
.Minutes
Due to.
Usual
9 Occupation :
housewife
Industry 10 or Business:
11 Social Security No ............. none
12 BIRTHPLACE (City)
Lust Boston
(State or country)
Mass
13 NAME OF
FATHER
John Ring
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
15 MAIDEN NAME
OF MOTHER
Julia Horrigan
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
17 Mary K. McPhillips
Relation, if any
Informant
(Address) Hathorno Hass.
A TRUE COPY. ATTEST :
(Registrar of city or town where death occurred)
19 43
DATE FILED
4 COLOR OR RACE| 5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED Wid.
5a if married, widowed, or divorced
HUSBAND of
(or) WIFE of
diva maiden
ne of wife in full y
(Husband's name in full)
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that fact here.
of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)
50m (e)-1-41-4667
PLACE OF DEATH
(County)
1
Danvers
(C'ity or Town)
CERTIFICATE OF DEATH
(If U. S.
War Veteran,
speolfy WAR)
(If nonresident, give city or town and State)
Reoelved and filed
MAY 1 3 1943
19
(Registrar of Clty or Town where deceased resided)
L
Underline the cause to which death should be charged sta- tistically.
Of autopsy.
What test confirmed diagnosis?
clinical
20 Was disease or injury In any way related to oooupatlon of deceased ?.
If so, speolfy
Leo Maletz
(Signed)
M. D.
(Address)
Hathorne, Mass.
Date
4/30.
19
43
Holy Cross Cemetery,
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Mulder ..
(Cemetery)
DATE OF BURIAL
Ma.y ..... ]
(City or Town)
19.43
22 NAME OF
FUNERAL DIRECTOR Frederick J. Magrath
ADDRESS
Boston ..... Mas ......
Date of
Physician
Other conditions.
(Include pregnancy within 3 months of death)
Major findings :
Of operations.
Due to
3 SEX female white
I R-305
Suffolk
(County)
Boston
(City or Town)
No. Mass. General Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Boston (City or town making return)
Registered No.
4397
5 (If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
21 Paine
st. .. Winthrop., .... Mas.s.
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution
(Before death)
years
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX M
4 COLOR OR RACE
5 SINGLE
(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)
6 Age of husband or wife if allve years
7 IF STILLBORN, enter that fact here.
AGE
8 63 Years Months. Days
If less than 1 day Hours .Minutes
Usual
9 Occupation :
Retired
10 or Business :
Industry
Folder Cotton Mill
11 Soolal Security No.
12 BIRTHPLACE (City) ...
Lewiston
(State or country)
Maine
13 NAME OF
FATHER
Patrick Carroll
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
17 Gerald Mccarthy
Relation, if any
Informant
(Address)
A TRUE COPY.
ATTEST :
Francis
(Registrar of city or town where death occurred)
DATE FILED May 4 19 43
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
April
30
(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.) Bilateral Pneumonia
Aortic Aneurism Recent Fractures Both Bones Rt. Lower
Leg
20 Acoldent, suicide, or homlolde (specify)
Accident
Date of ocourrenoe
Feb.
15
19.43
Where did
Winthrop
Injury occur ?
(City or town and State)
Did Injury oocur In or about the home, on farm, In Industrial place, or In publio place ? (Specify type of place)
Manner of
Fell accidentally at his home on
Injury
Nature of
February 15, 1943
Injury
While at work ?
Was there an autopsy ?.
21 Was disease or Injury In any way related to oooupation of deceased?
If so, speolfy
(Signed)
W. J. Brickley
M. D.
(Address)
Boston
Date.
4-30 19 43
22
Winthrop Cem.
Winthrop, Mass.
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
May ... 3
.19
43
23 NAME OF
J. F. O'Maley
FUNERAL DIRECTOR
ADDRESS
Winthrop
Received and filed
19
MAY 1 1 1943
(Registrar of City or Town where deceased resided)
.wwwwwwwwund uy u town at the time of death should be made forthwith and transmitted on Form R-305 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.)
25m (h)-1-41-4667
1
PLACE OF DEATH
William J. Carroll
St.
(If U. S.
War Veteran,
specify WAR)
(a) Residence. No.
(Usual place of abode)
(Specify whether)
1943
W
٥٠
301 A
PLACE OF DEATH
Suffolk (County)
Winthrop
No.
(City or Town)
252 Winthrop Shore Drive
The Commontoralth 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, 100
Registered No.
$ { If death occurred in a hospital or institution,
give Its NAME instead of street and nuniber)
2 FULL NAME
Annie J. ( Driscoll ) Brady
( If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No.
252 Winthrop Shore Drive
(Usual place of ahode)
St.
(If nonresident, give elty or town and State)
Length of stay: In hosoltal or Institution
(Before death)
( Specify whether)
years
months
days.
In this community25
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
4 COLOR OR RACEI
White
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORFARlowed
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
Gedfigen "Bradyin full)
( Husband's name in full)
6 Age of husband or wife if alive years
IF STILLBORN. enter that fact here.
8
73
AGE
Years
Months
Days
-
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
Housewife
Industry
10 or Business :
Own Home
11 Social Security No.
12 BIRTHPLACE (City)
( Siate or country)
Ireland
13 NAME OF
FATHER
Daniel Driscoll
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
15 MAIDEN NAME
OF MOTHER
Mary Henshon
16 BIRTHPLACE OF
MOTHER (City)
( State or country)
Ire land
Informant ( Address )
252 Winthrop Shore Drive
I HEREBY CERTIFY that a satisfactory standard certificate of death was filled with me BEFORE the burial or trangit permit was Usued : Um. Diebuldreas
HO ...
(Signature of Agent of Board of Health or othery may 143
.... (Omclal Designation) ( Date of Trgug of Fermit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
May-
6
1943
(Month)
(Day)
(Year)'
19 | HEREBY CERTIFY,
Abril
1
That ! attanded deosased from
19.
43.
to
May
6
19 43
I last saw h.
.allve on
May 6
1943, death Is said to
have occurred on the date stated above, at.
3.30 P.
.m.
Duration
Immedlate oause of death.
IMPORTANT
Coronary Thrombosis
18 hours
Due to
arterio Sclerosis
years
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 oooupation of deoeasad ?. NO
If so, spoolfy ...
(Signed ).
Edward Vitraus ge
, M. D.
(Address) 200 Ludoleursin THE Date May?
1943.
21
Holy Cross
Place of Burial, Cremation or Removal
Malden .... Mas.s
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