USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1952 > Part 18
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Medical examiners shall make examination upon the view of the dead bodies of persons as are supposed to have died by violence, or by the action of chemical, thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to oceupation, or suddenly when not disabled by recognizable disease, or when any person is found dead. - General Laws, Chap. 38, Sec. 6., as amended by Chap. 632. Sec. 4. Acts of 1945.
No undertaker or other persons 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 cemetery or burial ground in which the interment is made.
Chap. 114. Sec. 46, G. L., (Tercentenary Edition). .
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the follow- ing 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 deathsonly as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is 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.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very import- ant, 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 occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work dore during most of working life even if retired. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestie service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, eook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER
R-302 1
PLACE OF DEATH
(County)TON
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF
CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registered No.
1618
18
[(If death occurred in a hospital or institution, St. [ 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 Harborview Ave
Winthrop Mass
(If nonresident, give city or town and State)
Length of stay: In place of death .years ..
.months.
9
days. In place of residence.
50
.years
months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
February 23, 1952 (Month)
(Day) (Year)
4 I HEREBY CERTIFY.
Feb 14
19
5.2
to
Feb 23
19
52
I last saw h im alive on Feb 23 152
death is said to
have occurred on the date stated above, at.
3:15 P
n.
INTERVAL BE-
TWEEN ONSET
AND DEATH
Dys
ANTE Due To Acute & Chronic CEDENT (b) CAUSES pyelonephritis
Due To Renal stones &
(c)
recurrent carcinoma of rectum
OTHER SIGNIFICANT CONDITIONS
Major findings:
Carcinoma of rec tum
Of operations.
Date of operation.
Jun .... 1951 .. Was autopsy performed ?.
.Yes.
What test confirmed diagnosis ?. Autopsy
5 Was disease or injury in any way related to occupation of deceased ?. If so, specify. F DiPoncer M. D.
(Signed).
(Address) St Eliz Hosp Date Feb 23 1952
6 Winthrop Com
Winthrop Mass
Place of Buriafor Cremation
(City or Town)
DATE OF BURIAL.
Feb 26
1952
7 NAME OF
FUNERAL DIRECTOR
HS Reynolds
ADDRESS Winthrop Mass
Received and filed 19
MAR ... 3. ......... 1952
(Registrar of City or Town where deceased resided)
PARENTS
17 NAME OF FATHER
18 BIRTHPLACE OF FATHER (City) (State or country)
19 MAIDEN NAME OF MOTHER
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
21 Informant (Address) MinettaGriggs
A TRUE COPY har
Inackie
ATTEST!
(Registrar of City or Town where death occurred)
DATE FILED ......
........
Feb 26
19 .. 5.2
25M (E)-6-50-902253
after the close of the month in which the death occurred. (See Chap. 46, Ser 12, G. L.) of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time
years
years
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
81 Years
6
Months
3
Days
If under 24 hours
Hours ....
.Minutes
13 Usual
Occupation:
Printer
(Kind of work done during most of working life)
14 Industry
or Business:
City of Boston
15 Social Security No.
6 BIRTHPLACE (City) (State or country) New Brunswick
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No. (Usual place of abode)
Renforth C Bleakney
St Elizabeth's Hospital No.
5.
That
I attended
deceased from
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Uremia
-
-
-
of death should be transmitted on Form R-305 to the clerk of the city or town in which the deceased resided as soon as possible Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
PLACE OF DEATH
Middlesex
(County) Arlington
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Arlington
(City or town making return)
Registered No.
85
49
Non route to Symmes Arlington Hospital
[(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
James E. Conway
(If deceased is a married, widowed or divorced woman, give also maiden name.)
185 Somerset Avenue
St.
Winthrop .....
Mass
(If nonresident, give city or town and State)
Length of stay: In place of death
.years
months.
7
days.
In place of residence
21years.
.... months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
February .... 23
1952
(Month) (Day)
(Year)
9 SEX
Male
10 COLOR OR RACE
White
11 SINGLE
MARRIED
WIDOWED
or DIVORCED
Married
11a If married, widowed, or divorced
HUSBAND of.
Mary E. Malone
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
12 IF STILLBORN. enter that fact here.
13
AGE
Years
-
.Months.
...... Days
If under 24 hours
Hours.
Minutes
14 Usual
Occupation :
Ass't Adjudication Officer
(Kind of work done during most of working life)
15 Industry
or Business:
Veterans Administration
16 Social Security No ..
17 BIRTHPLACE (City)
(State or country)
Massachusetts
18 NAME OF
FATHER
James J. Conway
19 BIRTHPLACE OF
FATHER (City).
Cork
(State or country)
Ireland
20 MAIDEN NAME
OF MOTHER
Margaret F. Coppens
21 BIRTHPLACE OF
MOTHER (City)
East Boston
(State or country)
Massachusetts
22
Informant
Mary E. Conway
(Address) 185 Somerset Ave Winthrop
A TRUE COPY.
ATTEST:
(Registrar of City/or Town where death occurred)
DATE FILED
February
28
19
52
1
(Registrar of City or Town where deceased resided)
PARENTS
(Signed)
G. S. Miles
M. D.
(Address) Somerville Mass.
... Dat
2-23- 1952
7 Winthrop Winthrop, Mass
Place of Burial, or Cremation. (City of Town)
DATE OF BURIAL. February .26 .1952
8 NAME OF
FUNERAL DIRECTOR
Alice .... M ..... Kelly ..
ADDRESS
11 Meridian St. E. Boston
Received and filed
MAR.
FEB 10 1952
19
5.
25m-(c)-11-49-900.475
(City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in public place?
(Specify type of place)
Manner of
Injury
(How did injury occur?)
Nature of
Injury
While at work?
Was autopsy performed?
No
6 Was disease or injury in any way related to occupation of deceased? If so, specify.
Where did Injury occur?
... Cerebral Hemorrhage
5 Accident, suicide, or homicide (specify).
Date and hour of injury.
.19
4 I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.)
(a) Residence. No. (Usual place of abode)
(Was deceased a
U. S. War Veteran,
W.W. 1
if so specify WAR)
(write the word)
56
East Boston
R-305 1
e
of death should be 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.)
PLACE OF DEATH
SUFFOLK (COURSTON
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registered No.
1616
50
f(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
Steven Leavitt
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No.
(Usual place of abode)
433 Winthrop St
St.
Winthrop Mass
(If nonresident, give city or town and State)
Length of stay: In place of death
years.
.months.
.. days. In place of residence.
.. years ..
9
months.
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
February 23, 1952
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.)
11a If married, widowed, or divorced HUSBAND of (Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12 IF STILLBORN. enter that fact here.
13
AGE
Years
9
Months.
Days
If under 24 hours
Hours.
Minutes
14 Usual
Occupation :.
(Kind of work done during most of working life)
15 Industry or Business:
16 Social Security No.
17 BIRTHPLACE (City)
(State or country)
Winthrop Mass
18 NAME OF
FATHER
Meyer Leavitt
19 BIRTHPLACE OF
FATHER (City)
(State or country)
Boston Mass
20 MAIDEN NAME
OF MOTHER
Ruth Belsky
21 BIRTHPLACE OF
MOTHER (City)
(State or country) Boston Mass
Father
DATE OF BURIAL.
8 NAME OF
FUNERAL DIRECTOR
A Golov
ADDRESS Boston Mass
Received and filed MAR 3 1952 19
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
9 SEX
Male
10 COLOR OR RACE
White
11 SINGLE
MARRIED
WIDOWED
or DIVORCED
Single
Acute respiratory infection
5 Accident, suicide, or homicide (specify).
Date and hour of injury. 19
Where did
Injury occur?
(City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in public place?
Manner of
(Specify type of place)
Injury
Collapsed at home
(How did injury occur?)
Nature of
Dead on arrival at hospital
Injury
While at work?
Was autopsy performed?
no
6 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
W J Brickley
M. D.
(Address) Boston Mass
Date ..
Feb23 52
Workmen Circle Com 7 Place of Burial, or Cremation.
Melrose Mass
(City or Town)
Feb 24 1952
22
Informant
(Address)
A TRUE COPY.
ATTEST:
21 Mackie
(Registrar of City or Town where death occurred)
DATE FILED
Feb 26
.19 ..
52
....
+
R-305 1
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time
PARENTS
25m-(c)-11-49-900.475
No.
enroute to Mass Gen Hospital
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(write the word)
..
-
-
/50M (B)-12-49-900722
7 NAME OF FUNERAL DIRECTOR Vincent Rapino
ADDRESS
9 Chelsea St. East Boston
Received and filed 19
FEB 27 1952
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Feb.
(Month)
24
52
(Year)
Female
9 COLOR OR RACE
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED married
10a If married, widowed, or divorced
HUSBAND of ..
(Give maiden name of wife in full)
(or) WIFE of
Giuseppe Massullo
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 73
Years
Months ...
Days
If under 24 hours
.Hours ... Minutes
13 Usual
Occupation :
House Wife
(Kind of work done during most of working life)
14 Industry
or Business:
At Home
15 Social Security No.
none
16 BIRTHPLACE (City)
(State or country)
Italy
17 NAME OF
FATHER
Giuseppe Sforza
PARENTS
18 BIRTHPLACE OF
FATHER (City)
Italy
(State or country)
19 MAIDEN NAME
OF MOTHER
Anna (unknown),
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
21
Informant
AGNES Pelosi
(Address)
319 Sumner St. East Boston
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit perthit was issued: Walter &- Baker (Signature of Agent Of Board of Health on other) The atthe Office 2/27/50 (Official Designation) (Date of Issue of Permito 1
CTIONS R RTIFICATE
ving DEATH enter an one r each and (c)
es not mean dying, such re, asthenia, the disease, ions which
conditions. rise to the (a) stating ing cause
ns contrib- ath but not disease or sing death.
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
51
No.
Louise-Paul Rest Home
J(If death occurred in a hospital or institution,
St. [ give its NAME instead of street and number)
2 FULL NAME
Maddalena Massullo (If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 3 Wilbur Ct.
St.
(Was deceased a U. S. War Veteran. if so specify WAR)
no
(Usual place of abode)
Length of stay: In place of death years . 3 months 22 days.
In place of residence
years
.months
days.
MEDICAL CERTIFICATE OF DEATH
4 I HEREBY CERTIFY.
That I attended deceased from
19-4 9
to
Jeb. 12
I last saw he alive of 195 2, death is said to
have occurred on the date stated above, at
6:30 Rx
m.
INTERVAL BE-
TWEEN ONSET AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH
(desmond)
2 days
ANTE
Due Tovercho-vascular
CEDENT (b) .. CAUSES accident
3 mg
Due To
Jemendigel
OTHER
SIGNIFICANT
CONDITIONS
essential
Major findings:
Of operations
Date of operation.
Was autopsy performed?
What test confirmed diagnosis ?.
5 Was disease or injury in any way related to occupation of deceased? If so, specify .... .
M. D.
(Address)
Date 2-26
1952
6 Feb
Place of Burial or Cremation
DATE DI BUFMOSS Cemetery
(City or Town) Malden 19
52
Registered No.
PHYSICIAN - IMPORTANT -
East Boston
(If nonresident, give city or town and State)
8 SEX
(Day)
19$2
R-301A 1
Boston 7/52 3
EXTRACTS
FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith. after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased. his supposed age. the disease of which he died, defined as required 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.
A physician or officer furnishing a certificate of death as 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 army, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that cffect, specifying the war, and shall also certify in such certificate both the primary and the secondary or imme- diate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer, shall forfeit ten dollars. For the purposes of this section and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen. the word "war" shall include the China relief expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46. Sec. 10.
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 satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original inter- ment, 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 commonwealth 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 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-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 perunit. 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 registr .- tion. 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 persons as are supposed to have died by violence, or by the action of chemical, thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead. - General Laws, Chap 38, Sec. 6., as amended by Chap. 632, Sec. 4, Acts of 1945.
No undertaker or other persons 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 cemetery or burial ground in which the interment is made.
. Chap. 114, Sec. 46. G. L .. (Tercentenary Edition).
RULES OF PRACTICE
The fulfillinent of the purpose of these laws calls for the observance of the follow- ing 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 deathsonly as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is 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 traumatismı (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.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very import- ant, 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 occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write no.je.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING. ORGANIZATION AND OUTFIT SERVICE NUMBER
+-
Suffolk
(County)
Boston
(City or Town)
No.
Harley Hospital
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH 6 Windmere Road
Boston
(City or town making return)
1777-
Registered No.
52
¡(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME. Albert W Bowman
(If deceased is a married, widowed or divorced woman, give also maiden name.)
35 Bates Ave.
St.
(If nonresident, give city or town and State)
Length of stay: In place of death ..
.years.
.....
.months.
3
.days. In place of residence
35
ars.
months ..
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Feb.25/52
(Month)
(Day)
(Year)
8 SEX
M
9 COLOR OR RACE
W
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
4 I HEREBY CERTIFY,
That I attended deceased
from
52
Feb ..... 1.
19 ..
52
to
19
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Myocardial failure
INTERVAL BE- TWEEN ONSET AND DEATH 2 Days
11 IF STILLBORN, enter that fact here.
12
AGE 70
Years
2
Months
27
Days
If under 24 hours
Hours.
Minutes
ANTE
Due To
Uremia
CEDENT (b)
CAUSES
Due To
(c)
Diabetes mellitus
Arteriosclerosis
3 Days
13 Usual
Occupation:
Supt.Machine Shop
(Kind of work done during most of working life)
14 Industry
Interstitial nephritis 2 Weeksor Business:
3 Days 15 Social Security No.
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