Town of Winthrop : Record of Deaths 1943, Part 34

Author: Winthrop (Mass.)
Publication date: 1943
Publisher:
Number of Pages: 594


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 34


Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).


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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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