USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1955 > Part 26
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MARRIED
WIDOWED
or DIVORCED
(write the word)
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased
from
Feb.19
19
55
to
March 5
19
55
I last saw h .... 1m .. alive on
March 5 19.55
death is said to
10a If married, widowed, or divorced
HUSBAND of.
Jessie Ogus
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Pulmonary oedema
TWEEN ONSET AND DEATH 12 Hrs
11 IF STILLBORN, enter that fact here.
12
AGE ..
57
.Years
Months.
Days
If under 24 hours
Hours ....
.Minutes
13 Usual
Occupation:
Executive
14 Industry
or Business:
Bur lap Bag
15 Social Security No.
16 BIRTHPLACE (City).
(State or country)
Rus-si-a
17 NAME OF FATHER Harry Shore
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
19 MAIDEN NAME
OF MOTHER
Toby Ohlis
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
21
Informant
(Address)
Jack Shore
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
March 8/55
.19
DATE FILED
(Registrar of City or Town where deceased resided)
PARENTS
5 Was disease or injury in any way related to occupation of deceased ?. NO If so, specify
(Signed)
T ... D ... Novack
M. D.
(Address)
.Date
19
6
Cheyra .... Mishna ... Lynn Mass. Place of Burial or Cremation
(City or Town)
DATE OF BURIAL ..
March 6/55
19
-- H-J Torf
7 NAME OF
FUNERAL DIRECTOR
Chelsea Mass.
ADDRESS
Received and filed.
APR 251955
19
? 6 Mas
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
Osteogenic sarcoma rt,femur
Date of operation
Oct. 195 w
ed ?. Yes
What test confirmed diagnosis?
Path.Xrays
25M-10.53-910621
1,5 -
PLACE OF DEATH
ORM R-302 1
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
ANTE
Due To
CEDENT (b)
CAUSES
Metastatic osteogenic
sarcoma
have occurred on the date stated above, at. .1 ..: 07A .... m.
INTERVAL BE-
Married
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No. (Usual place of abode)
No.
Beth Isracabot.
V.B.V
(Kind of work done during most of working life)
RECEIVED
OF TOW
1 12
10
.: N
-3
6
APR25
RM R-305 1
PLACE OF DEATH
SUFFOLK BOSTON
(City or Town) enroute to E Boston Relief Sta
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)
2465 73
Registered No.
[(If death occurred in a hospital or institution. St. [ give its NAME instead of street and number)
Samuel Rosenthal
2 FULL NAME.
(If deceased is a married, widowed or divorced woman, give also maiden name.) 98 Locust St
St.
(If nonresident, give city or town and State)
Length of stay: In place of death ..........
.. years ..
months.
days. In place of residence.
........
... years ..
.months
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
9 SEXale
10 COLORIPHRASE
11 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write therolec
DEATH
(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.) Acute cardiac failure Chronic myocarditis
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 STILEBORN. enter that fact here.
If under 24 hours
13
AGE
Years.
Months
Capito Dea Haus
.....
.Minutes
14 Usual Occupation :. (Kind of fort, done(aring most of working life)
15 Industry
or Business:
013-12-6772
16 Social Security No.
Russia
17 BIRTHPLACE (City)
(State or country)
Abraham Rosenthal
18 NAME OF FATHER
Russia
19 BIRTHPLACE OF
FATHER (City)
(State or country)
Ida --
20 MAIDEN NAME OF MOTHER
21 BIRTHPLACE OF
Russia
....
MOTHER (City)
(State or country)
Ida ..... Slesingor
DATE OF BURIAL ..
19
8 NAME OF
FUNERAL DIRECTOR
Boston Mass
ADDRESS
Received and filed.
MAY 4 1955
19
(Registrar of City or Town where deceased resided)
51522
: 22
Informant.
(Address)
A TRUE COPY.
ATTEST: Sales 20 200
(Registrar of City or Town where death occurred)
DATE FILED
Mar 14
.19 ..
55
X
V
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
Injury 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.) 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 Injury
25m-(c)-11-49-900.475
If so, specify
(Signed)
W J Brickley
(Address)
Boston Mass
Date
3/9
19
M. D. 55
Sharon Mem Park Cem 7 Place of Burial, or Cremation. (City or- Town) Max
Sharon Mass
PARENTS
(Specify type of place)
Manner of
Collapsed and died en route
(How did injury occur?)
Nature of
to hospital
While at work?
Was autopsy performed?
6 Was disease or injury in any way related to occupation of deceased?
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?
5 Accident, suicide, or homicide (specify)
3 DATE OF
Mar 9, 1955
(Was deceased a U. S. War Veteran,
Winthroif WAR'S 9
(a) Residence. No. (Usual place of abode)
No.
T Birnbach
Gaybush
RECEIVED
TO
11
3
MIN
6 5
THRU
MAY -- 1 ٠٠١
ORM R-302 1
Suffolk (County) PLACE OF DEATH Boston y or Town )
Mass. General Hospt. No.
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.
2.500 7.1
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
(If deceased is a married, widowed or divorced woman, give also maiden name.) U.F. 412 416 Shirley St
(Was deceased a
U. S. War Veteran,
if so specify WAR)
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 ... 83 ... years.
.months.
.days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR OR RACE
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Single
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
AGE83
Years 7
... Months.
.Days
If under 24 hours
Hours ..
Minutes
13 Usual
Occupation:
Retired Fireman
(Kind of work done during most of working life)
14 Industry or Business:
Winthrop Fire Dept.
15 Social Security No.
None
16 BIRTHPLACE (City)
(State or country)
Winthrop M 33.
17 NAME OF
FATHER
Daniel A Floyd
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Winthrop .. Mass.
19 MAIDEN NAME
OF MOTHER
Carrie Allen
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Hillsborough N.H.
21
Informant
(Address)
MrL Floyd
A TRUE COPY
Carles & mackie
ATTEST:
(Registrar of City or Town where death occurred) March 15/55
DATE FILED
.19
(Registrar of City or Town where deceased resided)
PARENTS
7 NAME OF
FUNERAL DIRECTOR
Alfred B'Marsh
Winthrop Mass.
ADDRESS.
MAY 1
Received and filed 19
Declined By Medical Examiner
2 FULL NAME
Ellis Floyd
(a) Residence. No.
(Usual place of abode)
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
March 10/55
DEATH
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I
attended deceased from
March 10/ 55
Jan.9.
19.55.
to
I last saw h.1 ........ alive on
March 109/ 55
said to
have occurred on the date stated above, at
1.2 MODLITERVAL BE-
DISEASE OR CONDITION
DIRECTLY LEADING
Thrombotic occlusion of
TWEEN ONSET
ANO DEATH
TO DEATH (a)
anterior descending
Due To
coronary artery
24 Hrs
ANTE
CEDENT (b)
-10 Yra
Due To
(c)
OTHER
SIGNIFICANT
Pyelonephritis ,chronic
CONDITIONS
bilateral
2 Yrs
Major findings:
Of operations.
Date of operation.
Was autopsy performed ?.... Yes
What test confirmed diagnosis ?....... autopsy ..
5 Was disease or injury in any way related to occupation of deceased?No
If so, specify
(Signed)
C .... L .... Clay
M. D.
(Address)
Magg Gone HospPate .3-1.0 .1955
6
Winthrop Cem-Winthrop Mass.
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
March 11/55
19
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.)
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,
CAUSES
Cormary arteriosclerosis
25M-10-53-910621
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
MARGIN RESERVED FOR BINDING
RECEIVED
TO:
11 12
9:
MIN
6
2
MAY -4
ORM R-302 1
PLACE OF DEATH
Middlesex
(County)
Cambridge
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF
Cambridge
(City or town making return)
Registered No.
455 75
Cambridge Cits Hospital No.
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
Jemes Shea
2 FULL NAME.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
No
(a) Residence. No. 71 Sagamore Ave.
Winthrop
St
(If nonresident, give city or town and State)
Length of stay: In place of death
.years ..
15
.months.
.days.
In place of residence.
......
... years
months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF March
DEATH
-
30
1955
(Month)
(Day)
(Year)
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
MARRIED
(write the word)
WIDOWED
or DIVORCED
Marris
4 IHEREBY CERTIFY.
Har. 15
That I attended deceased from 55
19
im
.ar. 30
55€
19. death is said to INTERVAL BE-
have occurred on the date stated above. at
TWEEN ONSET AND DEATH
DISEASE OR CONDITION DIRECTLY LEADING Chorloopithilioma
TO DEATH , (a) ...
of testos with metastasis to
3 mo
12
AGE
Years
Months.
.. Days
If under 24 hours
.Hours ........ Minutes
13 Usual
Occupation:
Machinest
(Kind of work done during most of working life)
14 Industry
Lamb-Ritchie-Lamb
or Business:
15 Social Security No.
013-03-5183
Charlestown
16 BIRTHPLACE (City)
(State or country)
17 NAME OF
FATHER
John Shea
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Boston
19 MAIDEN NAME
OF MOTHER
Margaret Salisbury
20 BIRTHPLACE OF MOTHER (City) (State or country) England
21 Frances Shea
Informant (Address) (1 Sacrore Ave., ainthron
A TRUE COPY
Frederick H. Burke
(Registrar of City or Town where death occurred)
DATE FILED
April 4, 1955
.19
C
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.) 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,
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
25M· 10-53-910621
5 Was disease or injury in any way related to occupation of deceased? If so, specify .Edward T Domney (Signed) (Address) 115 Contith Ave Date.
M. D.
3/31
19 55
6 Holy Cross
Halden
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL April 4, 1955 19
7 NAME OF FUNERAL DIRECTOR 322 Bunkerhill
Joseph P. Turphy
ADDRESS:
Received and filed MAY 4 8405 19
(Registrar of City or Town where deceased resided)
10a If married, widowed, or divorced
HUSBAND of.
Frances
... c.Carthy.
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
42
lungs and brain
ANTE
Due To
CEDENT (b) CAUSES
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Major findings:
Of operations.
Yes
Date of operation
Was autopsy performed?
What test confirmed diagnosis ?.
PARENTS
Charlesto . ATTEST:
CERTIFICATE OF DEATH
(City or Town)
(Usual place of abode)
55
uar. 30
19
to
I last saw h
alive on
5:20P
n.
RECEIVED
TO
11.12
13:
5
6
MAY -- 13
RM R-303 A
N. B. - WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of MARGIN RESERVED FOR BINDING
If deceased was a U. S. War Veteran. G.L. Chap. 46, Section 10, requires physicians to insert a recital to that effect.
50M-10-53-910621
PLACE OF DEATH
Suffolk (County)
citRETT 4-29-55
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
76
Registered No. ..... .....
No En route to Winthrop Community Hosp.
William . Wright
(If deceased is a married, widowed or divorced woman, give also maiden name.)
38 Harvard St.
(a) Residence. No. (Usual place of abode)
(If nonresident, give city or town and State)
months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
amil 2
(fonth)
(Day)
1955 (Year)
9 SEX
Male Coined
11 SINGLE MARRIED (write the word) WIDOWED or DIVORCED Vanced
1 la If married, widowed, or divorced
HUSBAND of Mature Thanded
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
13
AGE 30 Years.
.. Months.
Days
If under 24 hours
Hours .......
. Minutes
14 Usual
Sand Hoa-
Occupation:
(Kind of work done during most of working life)
15 Industry
or Business:
16 Social Security No.
17 BIRTHPLACE (City)
(State or country)
18 NAME OF
FATHER
19 BIRTHPLACE OF
FATHER (City) ..
(State or country)
20 MAIDEN NAME
OF MOTHER
21 BIRTHPLACE OF
MOTHER (City) ..
(State or country)
22
Informant.
(Address)
.I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the buriahor transit permit was issued: Waller & Paper+
(Signature of Agent of Board of Health or other)
Health Price 415/55
(Registrar)
PARENTS
6 Was disease or injury in any way related to occupation of deceased? 12 If so, specify ..
(Signed ...
www .............. , M. D. (Address) 25 Shattuck St Date 4 /3 1955
7 Place of Burial, or Cremation. - (City or Town)
DATE OF BURIAL Drift
19,5
8 NAME OF FUNERAL DIRECTOR Meia
ADDRESS 658
Received and filed. APR 3 1950 / 19
of Death. See reverse side for extracts from the laws relative to the return of certificates of death. DEATH in plain terms, so that it may be properly classified under the International Classification of Causes information should be carefully supplied. MEDICAL EXAMINERS should stato CAUSE AND MANNER OF
5 Accident, suicide, or homicide (specify) ..
accident
Date and hour of injury.
april 2 19 55
Where did
Injury occur?
Boston
(City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in public
place?
IN PARTIALLY CONSTRUCTED
(Specify type of place)
Manner of
TUNNEL BENEATH BOSTON
Injury
(How did injury occur?)
Nature of
HARBOR -
CRUSHED BY
Injury
MACHINE
While at work?
.Was autopsy performed?
10 COLOR OR RACE
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.) CRUSH INJURY OF CHEST ...
WITH
RUPTURE OF HEART,
LUNG
AND LIVER
PHYSICIAN - IMPORTANT (Was deceased & U. S. War Veteran. ( if so specify WAR). Mano
Length of stay: In place of death. ...... .. years .. months. .days. In place of residence. ... years .
j(If death occurred in a hospital or institution,
St. [ give its NAME instead of street and number)
2 FULL NAME.
Winthrop (City or Toon)
(Official Designation) (Date of Issue of Permit) X
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 of 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 effect, 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 permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registra- 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. as amended by Chap. 48, Acts of 1927 and Chap. 414, Acts of 1931.
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried of the funeral is to be held, or from a person appointed to have the eare of the cemetery or burial ground in which the interment is made ...... .Chap. 114,
Sec. 46. G. L., as amended.
Medical examiners shall make examination upon the view of the dead bodies of persons" as ard ; 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 renotmizable disease, or when any person is found dead ..... - General Laws, Chap. 38, Sec- 6., as amended by Chap. 632, Sec. 4, Acts of 1945.
.!. The medical examiner certifies the cause and manner of death to the best of his knowledge and belief.'
RULES OF PRACTICE
The fulfilment of the purpose of these laws calls for the observance of the follow- ing rules of Htucnicei
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury,
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from Done 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 traumatisrh (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
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: "Compound fracture of the femur with ensuing septicemia (gas bacillus) caused by a steam railway accident.""Pistol shot wound of the chest with associated hemorrhage, hom- icidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether administered as a surgical anaesthetic." "Fracture of the skull with associated internal injury sustained 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 its known or presumable nature; and (2) under manner, indicate the circumstances leading to medico-legal inquiry. For example: "Hemorrhage spontaneous of the brain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)"
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT.
SERVICE NUMBER
X Suffolk (((inty;) Winthrop
1020 4-29-55
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
To be filed for burial permit with Board of Health or its Agent.
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
CORNELIUS 2 FULL NAME
MAHONEY
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, no if so specify WAR)
Charlestown
(If nonresident, give city or town and State)
months .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
APRIL (Month)
3 1955 (Year)
8 SEX
m.
9 COLOR OR RACE
10 SINGLE
MARRIEL
WIDOWED
or DIVOMarried
i
4 I HEREBY CERTIFY,
JAN
19
52
to.
That I attended deceased from
APRIL 3
1955
I last saw h / M alive on
4/
1
. 19 50 death is said to
10a
HUSBAND of ..
Anniver E. Baker
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
91
Years
Months
Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation :
Plumber
(Kind of work done during most of working life)
14 Industry
or Business :..
Plumbing
15 Social Security No ..
16 BIRTHPLACE (City) (State or country) Boston mass
17 NAME OF FATHER Cornelius mahoney
Major findings:
Of operations
HONE
Date of operation
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