USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1959 > Part 48
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. 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 front 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 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 none.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT
SERVICE NUMBER
R-301A
1
Winthrop
(City or Town)
Mayflower Nursing Home
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
Registered No.
[(If death occurred in a hospital or institution, St. [give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
Nora Creedon
Sullivan
¿ ¿ Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No.
(Usual place of abode)
28 Irwin St
St.
(If nonresident, give city or town and State)
Length of stay: In place of death.
years
6
. months.
. days. In place of residence 10
years.
months.
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
(write.the word)
or DIVORCEMarried
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
Jeremiah Creedon
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
67
12
AGE
Years.
Months.
Days
If under 24 hours
Hours ....... Minutes
13 Usual
Occupation :
Housewife
(Kind of work done during most of working life)
14 Industry
or Business:
Own Home
15 Social Security No ..
16 BIRTHPLACE (City)
(State or country)
Ireland
17 NAME OF
FATHER
Dennis Sullivan
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Ireland
19 MAIDEN NAME
OF MOTHER
Julia Howard
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
21
Jeremiah C reedon
Informant
(Address)
28 Irwin St. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Jack Ученые
(Signature of Agent of Board of Health or other)
Ho.
5/31/59
(Official Designation)
(Date of Issue of Permity
THIS IS A ENT RECORD. only APPROVED k or black ter ribbon.,. 2-2-57
UCTIONS OR CERTIFICATE
iving OF DEATH t enter han one for each b) and (c)
es not mean of dying, heart failure, c. It means · or compli- hich caused
s, if any, ve rise to ause
- (b)
Vascular Heart Disease
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
None.
Was autopsy performed?
What test confirmed diagnosis? Clinical
5 Was disease or injury in any way related to occupation of deceased? No If so, specify.
(Signed)
Charles Liberman
M. D.
(Address)
Winthrop Mas Date
8/29/1999
6
Winthrop
Winthrop (City or Town)
Place of Burial or Cremation DATE OF BURIAL August 31 59 19
7 NAME OF
FUNERAL DIRECTOR
Arthur J. O'Maley
Winthrop Mass.
ADDRESS
Received and filed AUG 31 1959 19
(Registrar)
INTERVAL BETWEEN ONSET AND
DEATH
1 day
Due T
Hypertensive- Cardio
August 28, 1959
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
Oct.
55
to ..
Aug. 28
19.
59.
I last saw h&Yalive on
A& q. 28, 1959, death is said to
have occurred on the date stated above, at
9:30 P.m.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
Coronary Occlusion acute
5yrs
(a), the under- ause
last.
ons contrib .. cath but not the terminal dition given
Chapter 137, 54, requires to print or cause or death on ificates.
P. 46, šš 9 & P. 114 $§ 45, AP. 38$ 6.)
-58-923886
PLACE OF DEATH
Suffolk (County)
To be filed for burial permit with Board of Health or its Agent.
No.
39 Grover- Ave
(If deceased is a married, widowed or divorced woman, give also maiden name.)
No
PARENTS
Ireland
3 DATE OF
DEATH
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
-DATE OF DISCHARGE RANK, RATING. ORGANIZATION AND OUTFIT SERVICE NUMBER .......
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 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 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 thoseroff : VED 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-1 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. 2 Por a person engaged in domestic service for wages, however, designate the occupation e by the appropriate terms, as housekeeper-private family, cook-hotel, etc. "For a person who had no occupation whatever write none.
AUG 3 1 1550 44
IR-303 A 1
PLACE OF DEATH
X Suffolk (County) Winthrop (City or Towny ....
The Commonwealth of Alassachusetts JOSEPH D. WARD 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.
Registered No.
No. 335 Winthrop St.
[(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
2 FULL NAME
....
Benson
(DOYLE
(If deceased is a married, widowed or divorced wontan, give also maiden name.) 335 Winthrop St Mintha
(a) Residence. No. (Usual place of abode)
Length of stay : In place of death .. .years ..... 6
2
months .............. days. In place of residence .... years .. .... months ............ days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
August 29
(Day)
(Mont
1959 (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.)
RHEUMATIC HEART DISEASE WITH AORTIC STENOSIS ACUTE CARDIAC DECOMPENSATION
5 Accident, suicide, or homicide (specify)
Date and hour of injury 19
IF ACCIDENTAL, was injury causally related to the death? 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 ?
(Specify type of place)
Manner of
(How did injury occur?)
While at work ?
.Was autopsy performed ?
yes
6 Was disease or injury in any way related to occuration of deceased ?..
(Signed)
....
i so, what Thuongo
M. D.
MICHAEL A. LUONGO M.D. (Print or Type Signature)
(Address)
7 HOLY CROSS MALDEN
Place of Burian, or Cremation
DATE OF BURIAL SEPT 2
8 NAME OF
FUNERAL DIRECTOR LESLIE W PIKE
ADDRESS 305 BEACH ST REVERE
Received and filed
SEP 10 1959
19.
PARENTS
18 NAME OF
FATHER
JOSEPH E DOYLE
19 BIRTHPLACE OF
FATHER (City)
805
(State or country)
IRELAND.
20 MAIDEN NAME
OF MOTHER
MARGARET DONOVAN
21 BIRTHPLACE OF
MOTHER (City)
BOSTON
22
HERMAN W. BENSON
Informant
(Address)
335 WINTHROP ST
(Signature of Agent of Board of Health or other)
€ 21366
8731/09
(Official Designation) (Date of Issue of Permit)
( Registrar)
9 SEX
10 COLOR
11 SINGLE
MARRIED
(write the word) WIDOWED MARRIED.
or DIVORCED
11a If married, widowed, or divorced HUSBAND of
(or) WIFE of ..
(Give maiden name of wife in full) HERMAN W BENSON.
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
13
AGF 30
Years.
.Months.
.Days
If under 24 hours Hours .Minutes
14 Usual
Occupation :
AT HOME HOUSEWIFE
(Kind of work done during most of working life)
15 Industry
or Business :
NONE AT home
16 Social Security No.
034-20-8764
17 BIRTHPLACE (City)
(State or country)
REVENE
MASS
Borton 8/30 1959 Date .... (State or country) MASS
25M-3-59-924934
Injury Injury of Death. See reverse side for additional information. See also Chap. 38, §§ 6, 20; Chap. 46, §§ 9, 10; Chap. 114, §§ 44-48. If deceased was a U. S. War Veteran, G.L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. 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 state CAUSE AND MANNER OF Nature of
FEMALE WHITE
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, {if so specify WAR)
(If nonresident, give city or town and State)
(City or Town) 195919 ... 19. I HEREBY CERTIFY that a satisfactory standard was filed with me BEFORE the burial or transit permit was Issued! Claire Baldwin
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RECEIVE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
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 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 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 poison) 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 collision of railroad train and automobile." "Pistol shot wound of the chest with associated hemorrhage, homicidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether ad- ministered as a surgical anaesthetic for (enter name of operation and disease or condition requiring surgery)." "Frac- ture 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.)"
R-301A
KHREINER
1
PLACE OF DEATH
Suffolk (County)
CHILLIAO
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD
CERTIFICATE OF DEATH
Registered No.
f(If death occurred in a hospital or institution,
St. (give its NAME instead of street and number)
2 FULL NAME Bertha Loessol
(Loess!)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No.
104 Highland Ave
(Usual place of abode)
Length of stay: In place of death ..
3
.years ............ months.
days. In place of residence
3
.years ......_.. .. months _..... .. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
white
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
widow
10a If married, widowed, or divorced HUSBAND of
(or) WIFE of
C. Henry
(Give maiden name of wife in full)
Loass!
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
83
12
AGE Q
Years.
Months
.Days
If under 24 hours
Hours ..... Minutes
13 Usual
Occupation :
Housewife
(Kind of work done during most of working life)
14 Industry
or Business:
At Home
15 Social Security No.
16 BIRTHPLACE (City) Loeven Fald (State or country) Germany
17 NAME OF
FATHER
unable to learn Petroll
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Germany
19 MAIDEN NAME
OF MOTHER
unable to learn
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Germany
21 Mis Jeannette Johnston Informant (Address) Fort Banks Winthrop
I HEREBY CERTIFY that a satisfactory, standard certificate of death was filed with me BEFORE the burial or transit permit was issued :
(Signature of Agent of Board of Health or other)
HO
alte ang. 31/59
(Official Designation)
(Date of Issue of Permit)
UCTIONS OR CERTIFICATE
BY ME
diving OF DEATH t enter han one for each b) and (c)
es not mean of dying, eart failure, c. It means ,or compli- hich caused
s, if any, ve rise to ause (a), the under- use last.
ons contrib- ath but not the terminal dition given
Chapter 137, 54, requires to print or cause or death on
ificates. P. 46, §§ 9 & P. 114 $$ 45, AP. 38$ 6.)
6 Forest Hills
Boston
Place of Burial or Cremation
DATE OF BURIAL
Sept 1
7 NAME OF
FUNERAL DIRECTOR
P.5 murray
ADDRESS
54 Roxbury St Roybory
Received and filed AUG 31-1959 19.
(Registrar)
2 DAYS
OTHER
SIGNIFICANT
CONDITIONS
NONE
Was autopsy performed?
150
What test confirmed diagnosis ?.
CLINICAL
5 Was disease or injury in any way related to occupation of deceased 00 If so, specify
(Signed)
., M. D. (Address)22 PLEASANT ST NINTHEIR 8/24 54
INTERVAL BETWEEN ONSET AND DEATH
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
ARTERIO- SCLEROTIC
(a)
ACHAT DISEASE WITH
Due To
CONGESTIVE FAILURE
1YR.
(b)
ACUTE GASTROENTERITIS.
Due To (c)
AVG
(Month)
29
1959
(Year)
(Day)
That I attended deceased from
4 I HEREBY CERTIFY,
HUG 28
19
to
Hier 29
1955
I last saw h
AVE
28
, 1957, death is said to
have occurred on the date stated above, at 939A m.
St.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(If nonresident, give city or town and State)
To be filed for burial permit with Board of Health or its Agent.
Mount's combelescent glome 104 Highland Ave., Winthrop No.
Winthrop (City or Town)
THIS IS A ENT RECORD only APPROVED k or black ter ribbon.
TURISDICINO
-58-923886
(City or Town) 19
3 DATE OF
DEATH
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER.
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 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 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 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 none.
AUG 311350 /11
A R-303 A
1
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD 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.
Registered No.
No.
62 Ingetside Ave., Winthrop
St. ¿ give its NAME instead of street and number)
2 FULL NAME
WILLIAM MCMURRAY
(If deceased is a married, widowed or divorced wonian, give also maiden nanie.)
Le
PHYSICIAN - IMPORTANT
] (Was deceased a
U. S. War Veteran,
if so specify WAR)
No
62 Ingelside Avenue
St
Winthrop,
Mass.
(a) Residence. No.
(Usual place of abode)
(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
3 DATE OF
DEATH
August
29
1959
(Montlı) (Day)
(Year)
9 SEX
Male
IO COLOR
White
1I SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
4I 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.)
Ila If married, widowed, or divorced
HUSBAND of
Clara ... Boudreau
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
13
AGE ..... 56 Years
Months.
Days
If under 24 hours
Hours
Minutes
14 Usual
Occupation :
Sales Engineer
(Kind of work done during most of working life)
15 Industry
or Business :
Self
16 Social Security No.
East Boston
Manner of
Injury
No in jury
(How did injury occur ?)
While at work ?
Was autopsy performed? Yes
6 Was disease or injury in any way related to occupation of deceased?
(Signed MichaelA. Luongo, M. D.,
(Print or Type Signature)
(Address) Boston, Mass. Date .. 8/29 19 ... 5.9
winthrop
Winthrop
22
Informant
Clara ... McMurray
62 Ingelside Aves
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
FUNERAL DIRECTOR
ADDRESS
210 Winthrop St. Winthrop
Received and filed
SEP 1 1959
19
PARENTS
18 NAME OF
FATHER
John McMurray
19 BIRTHPLACE OF
FATHER (City)
Glasgow.
(State or country)
Scotland
20 MAIDEN NAME
OF MOTHER
Jane Kelley
21 BIRTHPLACE OF
MOTHER (City)
Glascow
(State or country)
Scotland
7 Place of Burial, or Cremation. "Win. ComCity or Wwn)
DATE OF BURIAL Sept ...... l.,
inthrop Address) 19 .. 5.9. ..
So, S §§ 44-48. of Death. See reverse side for additional information. See also Chap. 38, §§ 6, 20; Chap. 46, §§ 9, 10; Chap. 114, DEATH in plain terms, so that it may be properly classified under the International Classification of Causes If deceased was a U. S. War Veteran, G.L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF 25M-3-59-924934 . JN. D. WRITE FLAINLI, WITTY ONTADINO DLALA INA TIO WO A ILAMANENT RECORD. Every Item of Nature of Injury
5 Accident, suicide, or homicide (specify) Date and hour of injury 19
IF ACCIDENTAL, was injury causally related to the death?
Where did
Collapsed while operating
Injury occur ?
(City or town and State)
motor
Ga
Or about home, on farm, in industrial place, or in
public place ?
(Specify type of place)
17 BIRTHPLACE (City)
(State or country)
M. D.
8 NAME OF
Maurice W Kirby
(Signature Agent of board of Health or other)
4.0
de,6 1/59
-
(Official Designation)
(Date of Issue of Permit)
Arteriosclerosis of coronary art- eries with acute coronary insuff- Ciency.
§(Ii death occurred in a hospital or institution,
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE .
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of thefollowing 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 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 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 poison) 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 collision of railroad train and automobile." "Pistol shot wound of the chest with associated hemorrhage, homicidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether ad- ministered as a surgical anaesthetic for (enter name of operation and disease or condition requiring surgery)." "Frac- ture 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.)"
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