USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1944 > Part 30
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it has heen engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certlocate, shall forthwith countersign it and transmit it to the clerk of the town for regis- tration. The person to whom the perunit is so given and the physician cer- tifying the cause of death shall thereafter furnish for registration any other necessary information which can he obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may re- quire .- Chap. 114, Scc. 45, G. L., (Tercentenary Edition).
No undertaker or other person shall bury a human hody or the ashes thereof which have been brought into the commonwealth until he bas re- ceived 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 he held, or from a per- son appointed to have the care of the cemetery or burial ground in which the interment is made .... Chap. 114, Sec. 46, G. L., (Tercentenary Edi- tion).
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to liave died by 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 body 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; otherwise a description as full as may he, 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 helief.
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 hedside 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 hy recognized disease unrelated to any form of injury, have died without recent medical attendance or wbose physi- cian is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths sup- posably 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 deatbs 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.
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: "Com- pound fracture of the femur with ensuing septicemia (gas bacillus) caused hy a steam railway accident." "Pistol shot wound of the chest with asso- ciated hemorrhage, homicidal." "Asphyxiation hy suspension, suicidal." "Syncope while under the influence of ether administered as a surgical anaesthetic." "Fracture of the skull with associated internal injury sua- tained under circunstances 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 presumahle nature; and (2) under manner, indicate the circum- stances leading to medico-legal inquiry. For example : "Ilemorrhage spon- taneous of the hrain ( hasal ganglia) (found dead in bed)." "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
-301 A
1
PLACE OF DEATH
(County)
Winthrop
(City or Town)
No.
1.0.9 ..... Pleasant.
The Commonmoralth 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 Agents
Registered No.
( It death occurred in a hospital or institution, St.
give ita NAME instead of street and nuniber)
2 FULL NAME
Daniel Gallagher
(If deceased is a married, widowed or divorced woman, give also maiden name.)
PHYSICIAN - IMPORTANT
(Wes deooased a
U. S. Wer Veteren,
if so specify WAR)
No
(a) Residence. No.
109 .... Pleasant
(Usual piace of abode)
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay: in hosoltal or Institution
(Before death)
(Specify whether)
years
months
days.
In this community 11
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE!
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCEDWidowed
Male White
5a If married, widowed, o HUSBAND of
divorced Bradley
(Give maiden name of wife in full)
(or) WIFE of
( Husband's name in full)
6 Age of husband or wife if alive years
> IF STILLBORN. enter That fact here.
8
AGE .. 9.4
Years
Months
Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
Laborer -
Retired
Industry
10 or Business :
City of Boston
11 Social Security No.
None
Donegal
12 BIRTHPLACE (City)
(State or country)
Treland
13 NAME OF
FATHER
Daniel Gallagher
14 BIRTHPLACE OF
FATHER (City)
Donegal
(State or country)
Treland
15 MAIDEN NAME
OF MOTHER
Anne Smith
16 BIRTHPLACE OF
MOTHER (City)
....
Donegal
(State or country)
Treland
21
Holy Cross
Malden
Mass.
(City or Town)
Piece of Burial, Creniation or Removal.
DATE OF BURIAL .... May.
2
1944
22 NAME OF
FUNERAL DIRECTOR Frank H Carr
ADDRESS
82 Bunker Hill St Charlestown.
Received and Aled
1946
19
( Registrar)
100M-6 -2-42-8855
I HEREBY CERTIFY that a satisfactory standard certifioste of death was filed with me BEFORE the burial or transit permit was issued : Im. S. Childersex-
Signature of Ageft of Board of Health or other)
He atthe Office 5/4/4/
.... (Official Designation) ( Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
April
30
1.944.
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY,
That i attended deosased from
...
.m.
I Wast saw h
man alive on.
a har 29, 1944, death Is said to
have occurred on the date stated above, at 5.15 P.
Duration Immediate oouse of death.
IMPORTANT
Due to
......
Due to
Other conditions.
( Include pregnancy within 3 months of death)
IMPORTANT
Physician
Major findIngs :
Of operations
Dete of
Of eutopsy
What test confirmed diagnosis ?.
Underline the cause to which death should be charged sta- listically.
20 Was disease or injury in any way related to oooupation of deoeased ? 40
If so, specify ..
(Signed) C) Mahoney
. M. D.
(Address)
Y Washington en Date 5-1-
1974
John Gallagher Relation, if any
17
Informant
( Address )
109 Pleasant St Winthrop
......
extracts from the laws on back of certificate. If deceased was a U. S. War Veteran, G. L. Chap. 46, Sootlon 10, requires physicians to insert a reoital to that effect. PARENTS
43.
april 30
1975
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physiolan or registered hospital medical officer shall forthwith, after the death of a person whoin he has attemled during his last illness, at the request of an undertaker or other suthorized person or of sny meniher of the family of the deceased, furnish for registration a standard certificate of desth, stating to the best of his knowledge and helief the name of the deceused, his supposed age, the disesse of which he died. defined as re- quired hy section one, where ssme was contracted. the duration of his last illness, when last seen alive hy the physician or omcer and the date of his death ... Gen. Laws, Clap. 16, Sec. 9.
A' physician or officer furnishing a certificate of death aa required by the preceding section or by section forty five of chapter one hundred and four- teen, shall, if the deceased, to the best of his knowledge and belief, served in the ariny, usvy or marine corps of the I'nited States in any war in which it has been engaged, insert in the certificate s recital to that effect, speci- fying the war. sud shall also certify in such certificate hoth the primary and the secondary or iinmediate cause of death as nearly as he can state the saine. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this aec- tion and of sections forty-five, forty-six and forty-seven of said chapter one bumilred and fourteen, the word "war" shall include the China relief ex- pedition sud the Philippine insurrection, which shall, for said purposes, he deencd to have taken place between February fourteenth, eigliteen hundred and ninety-eigiit and July fourth, nineteen hundred and two, and the Mexi- can border service of nineteen hundred aud sixteen and nineteen bundred and seventeen. G. L. Chisp. 16, Sec. 10.
No undertaker or other person shall hury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not heen huried, until he has received a permit from the hoard of health, or ita agent appointed to issue wucb permita, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other pervou shall exhume a human body and remove it froin a town, from one cemetery to another, or from oue grave or tomh other than the receiving tonih to another in the same cemetery, until he has received a permit from the board of health or ita agent aforesaid or from the clerk of the town where the holy is buried. No such permit shall he issued until there shall have been delivered to such board, agent or clerk, as the case inay he, a satisfactory written atatement containing the facts required by law to he returned and recorded, which shall he accompanied, in case of an original internient, by a satisfactory certificate of the attending physician, if any, as required by law, o1 in lieu thereof a certificate as ilereinafter provided. If there ia no attending physician, or if, for sufficient reasons, his certificate cannot he obtained early enough for the purpose, or ie insufficient, a physi- cian who is a member of the board of health, or employed by It or hy the selectmnen for the purpose, shall upon application niake the certificate re- quired of the attending physician. If death is caused by violence, the medi- cal examiner shall make such certificate. If such a permit for the removal of a liuman hody, not previously interred, froin one town to another within the counmnouwealth cannot be obtained early enough for the purpose, the certificate of desih made as ahove provided and in the posaession ot the undertaker desiring to make such 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 obtained hereunder. If the death certificate contains a recital, as required
by section ten of chapter forty-wix, 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 ageut. upon receipt of such statement and certificate, shall forthwith countersign it and transnilt 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 ueces eary infurniation which cau he obtained as to the deceased. or as to tha 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 hury a hunian hody or the ashes thereof which have been brought Into the commonwealth until he has re- ceived & 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 hody is to be buried or the funeral is to he held, or from a person appointed to have the care of the cemetery or burisl grouml in which tha internient is made. ... Chap. 114. Sec. 16. G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of only such persons as sre supposed to have died hiy violence. If a medical examiner has notice that there is within lils county the body of such a person, he shall forthwith go to the place where the hundly iies aud take charge of the same; ... - General Laws, Chap. 38, Sec. 6.
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 hedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physloians will certify to such deaths only as those of persons who, though disahled hy recognized disease unrelated to any form of injury. have died without recent medical attendance or whose phyaf- cian is ahsent from home when the certificate of death is needed.
(3) Medloai Examiners will investigate and certify to all deaths sup- posably due to Injury. These include not only deaths caused directly or In- directly hy traumatism (including resulting septicemia), and hy the action of clienical (drugs or poisons), therinal, or electrical agents, aml deaths following abortion, hut also deathe from diseass resulting from injury or infeotion relsted to occupation, the sudden deaths of persons not disablad 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 ilylug. e. g., heart fallure, asphyxia, asthenia, etc. Aa 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.
Statement of Occupation .- Precise statement of occupation is very im- portaut, so that the relative beaithfulness of various pursuits can be known. Make some eutry in this section for every person aged 10 years or over. If the occupation had been given up or changed ou account of the dixcase causing death, report the usual occupation prior to illness. If the deceased bad retired from businesa, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at hoine. For a woman whose only occupatiou waa that of honie housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terma, as bousekerper-private faniily, cook-hotei, etc. For a person who bad no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
ORM R-302
Essex
The Commomuralth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Danvers
(City or town making return)
1
Danvers
(City or Town)
No. Danvers state Hospital
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
43 Locust
St.
winthrop
(If nonresident, give city or town and State)
Length of stay : In hospital or Institution
(Before death)
(Specify whether)
years
Imonths
1
days .
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
male
4 COLOR OR RACE|
white
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
DEATH
widowed
(Month)
(Day)
(Year)
5a If married, widowed, or divorced
HUSBAND of
Alice Clent
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if aiive years
7 IF STILLBORN, enter that fact here.
8
AGE
82
Years
Months.
Days
If less than 1 day
.Hours.
Minutes
Usual
Retired painter
9 Occupation :
Industry 10 or Business :
Il Social Security No. cannot be learned
12 BIRTHPLACE (City)
(State or country)
England
13 NAME OF
* FATHER
John Grant
14 BIRTHPLACE OF
FATHER (City)
England
(State or country)
15 MAIDEN NAME
OF MOTHER
Lydia
-
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Lngland
17 M. K. McPhillips
Relation, if any
Informant
(Address)
A TRUE COPY.
ATTEST :
at nestaChan.
(Registrar of city or, town where death occurred)
DATE FILED
4/10/44
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
April 4, 1944
19 | HEREBY CERTIFY,
That I attended deceased from
Mar
3.
19 ...
4.4
to
4 ... , 19 .... 4.4
I last saw h .. ]m ..... alive on ...
Apr ..
4 ...... , 19 .... 44death is sald to
have occurred on the date stated above, at
3 P.
m.
Duration
Immediate cause of death
Arteriosclerotic heart disease ......... yr.
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.
What test confirmed diagnosisclinical
20 Was disease or injury In any way related to occupation of deceased ?.
If so, specify.
(Signed) Abraham Gardner
DSH
(Address)
Date
4/6
M. D.
19.
44
21 PLACE OF BURIAL,
winthrop
winthrop
19
CREMATION OR REMOVAL ..
(Cemetery2 /8/44
(City or Town)
22 NAME OF
FUNERAL DIRECTOR
Kirby Brothers
ADDRESS
Winthrop
Received and filed
MAY 11 1944
19
(Registrar of City or Town where deceased resided)
Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.) resided in another city or town at the time of death should be made forthwith and transmitted on Form R-302 to the clerk
PARENTS
50m (e)-1-41-4667
PLACE OF DEATH
(County)
Registered No.
92
Frederick Grant
St. ( If death occurred in a hospital or Institution, ¿ give its NAME instead of street and number) 1 (If U. S. party WARS
DATE OF BURIAL
Underline the cause to which death
Of autopsy
Apr ..
(Give maiden name of wife in full)
RM R-302
PLACE OF DEATH
Suffolk (County)
The Commonturalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Chelsea
(City or town making return) 93
229
Registered No.
S (If death occurred in a hospital or institution,
3 give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
127 Bowdoin
St.
Winthrop Mass.
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution
(Before death)
(Specify whether)
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE!
5 SINGLE
(write the word)
18 DATE OF
DEATH
Apr.8,1944
(Month)
(Day)
(Year)
19
HERE BY
CERTIFY,
44
19
to
4/8
19
44
I last saw h
Efire on.
1/8
have occurred on the date stated above, at.
10:500.
Duration
6 Age of husband or wife if alive 6.0
years
7 IF STILLBORN, enter that fact here.
8 AGE 6×gars .. .... 6Months.
If less than 1 day
Hours .......
Minutes
Usual
9 Ocoupation :
Supervisor of Attendance
Industry 10 or Business :
11 Social Security No .. none
12 BIRTHPLACE (City)
(State or country)
Boston, Mass.
13 NAME OF
FATHER
William
Major findings :
Of operations
Date of
should be charged sta-
Of autopsy
What test confirmed diagnosis ?.
clinical
20 Was disease or injury in any way related to occupation of deceased ? If so, specify.
(Signed)
PaulFeinsaft
M. D.
(Address)
Soldiers' Hombate 4/9 19.
..... 44
21 PLACE OF BURIALT.
CREMATION OR REMOVALCem. Winthrop, Mass.
(Cemetery)
Apr . 11, 194 Gity or Town)
19
DATE OF BURIAL
Chas .H.Treanor
A TRUE COPY.
ATTEST :
(Registrar of city or town (where death occurred)
DATE FILED
/
4/9/44
19
Reoelved and filed MAY 13-1944
(Registrar of City or Town where deceased resided)
Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased
50m (e)-1-41-4667
resided in another city or town at the time of death should be made forthwith and transmitted on Form R-802 to the clerk
of the city or town in which the deceased resided. (See Chap. 16, Sec. 12, G. L.)
PARENTS
14 BIRTHPLACE OF
FATHER (City)
Boston, Mass -.
(State or country)
15 MAIDEN NAME
OF MOTHER
Anastasia Welch
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Boston, Mas.S.
17
Informant
(Address)
Hospital Records
Relation, if any
Soldiers ........ Home ... Hospital
22 NAME OF
FUNERAL DIRECTOR59-Saratoga St.E.Boston
ADDRESS
19
1
Chelsea
(('ity or Town)
No. Soldiers ........ Home .... Hospital
St.
William E.Killilea
(If U. S.
War Veteran,
specify WAR)
WWW1
(a) Residenoe. No.
(Usual place of abode)
MARRIED
WIDOWED
or DIVORCED
Marride
5a If married, widowed, or divorced
Sullivan
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
Immediate oause of death
Coronary heart disease
3m.o.s .
Due to.
Generalized arterio
sclerosisand ... hypertension
2.10yrs
Due to
Other conditions
Passive ..... congest.i.o.n
(Include pregnancy within 3 months of death)
3wks. Physician
Underline the cause to which death
tistically.
That I attended deceased from
.. , 19
.... 4death Is sald to
M
hospita tears
10
RM R-302
Suffolk
The Commonturalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF
Chelsea
(City or town making return)
94
246
No.
Soldiers' Home Hospital
St.
( If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Frederick J. Jenney
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
127 Quincy Ave.
St.
(If nonresident, give city or town and State)
Length of stay: In hospital or institution ..
(Before death)
(Specify whether)
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE
5 SINGLE
(write the word)
18 DATE OF
Apr.18,1944
DEATH
(Month)
(Day)
(Year)
5a If married, widowed, or divorced,
HUSBAND of
Mary E. Donovan
(or) WIFE of
(Hushand's name in full)
6 Age of husband or wife If alive years
7 IF STILLBORN, enter that fact here.
8
AGE
66ars.
.OMonths .....
.2.5ays
If less than 1 day
.. Hours ..........
Minutes
Usual
9 Occupation :
Police Officer
Industry
Metropolitan Dist.Comm
11 Social Security No ..... none
12 BIRTHPLACE (City)
(State or country)
Roxbury, Mas.s.
13 NAME OF
FATHER
Frederick J.
PARENTS
14 BIRTHPLACE OF
FATHER (City)
Switzerland
(State or country)
15 MAIDEN NAME
OF MOTHER
Sofia K.Kroger
16 BIRTHPLACE OF
MOTHER (City)
Germany
(State or country)
17 Hospital Record
Relation, if any
21 "PLACE OF BURIALIPOD
CREMATION OR REMOVAL Com. Winthrop, Mass.
(Cemetery pr . 21, ](gter Town)
19
DATE OF BURIAL
John F. O'Maley
A TRUE COPY.
ATTEST :
{Registrar ot town where death occurred) 71 19
22 NAME OF
FUNERAL DIRECTOR
Atlantic st. inthrop
ADDRESS
Received and filed
MAY 1.3 1944
19
(Registrar of City or Town where deceased resided)
50m (e)-1-41-4667
of the city or town in which the deceased resided. (See Chap. 46, Scc. 12, G. L.) resided in another city or town at the time of death should be made forthwith and transmitted on Form R-802 to the clerk Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased
PLACE OF DEATH
(County)
1
Chelsea
(City or Town)
CERTIFICATE OF DEATH
Registered No.
(If U. S.
War Veteran,
specify WAR)
Spanish
M
MARRIED
WIDOWED
or DIVORCED
Vidowed
19 | HEREBY CERTIFY,
Apr. 1419 44
to
Apr. 18
19
That i attended deceased from
44
I last saw h
Etye on.
A.pr .... 18 .. , 19 ....... 4death Is sald to
have occurred on the date stated above, at.
1:45 .... 01
Duration
Immediate oause of death
Heart ...... failure
24 .... hrs
Due to.
Myocarditis
7
Due to.
Cerebral vascular accident
5 das.
(Include pregnancy within 3 months of death)
disease .. Arteriosclerosis
Major findings :
Of operations.
Date of.
UnderMne. 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 occupation of deceased?
If so, specify
(Signed)
Alexander Roubley
M. D.
(Address)
Soldieret komlate ...
4/18 44
Informant
(Address)
DATE FILED
Other conditions .........
Coronary heart
Physician
10 or Business :
(Give maiden name of wife in full)
Winthrop, Mass.
(Usual place of ahode)
hospital.
R-301 A
PLACE OF DEATH
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