USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1960 > Part 28
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PLACE OF DEATH
SUFFELIZ (County)
WINTHROP (City or Town) No. 66 SHORE DRIVE ALICE ROWE
The Commonwealth of Massachusetts JOSEPH D WARD 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.
126
{(If death occurred in a hospital or institution, PEST HOLST. give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 59 COTTAGE AVE. St
(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 72 years. months .. ....... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
5-29
- 60
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
56
That I attended deceased from
1960
to
may 26
I last saw h. x .. alive on
May
26
19 60 death is said to
have occurred on the date stated above, at
3:45
.m
INTERVAL
BETWEEN
ONSET AND
DEATH
4yrs.
12
AGE 91 Years
Months .....
Days
If under 24 hours
Hours.
Minutes
13 Usual
HOME MAKER
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business :
HOME
15 Social Security No.
NONE
ROCKLAND
16 BIRTHPLACE (City)
(State or country)
ME.
17 NAME OF
FATHER
JOSHVAN, ROWE
18 BIRTHPLACE OF
FATHER (City)
ROCKLAND
1
(State or country)
ME
19 MAIDEN NAME
OF MOTHER
CAROLINE KEATING
20 BIRTHPLACE OF
(Address)
Vint
theop Mass Date.
5.29
.19
60
MOTHER (City)
ROCKLAND
WOODLAWN CREMATORY EVERETT.
(City or Town)
Place of Burial or Cremation
DATE OF BURIAL
JUNE
1
1966
7 NAME OF
MAURICE W KIRBY
ADDRESS
WINTHROP
Received and filed
JUN 1 1960
19
(Registrar)
8 SEX
FEMALE
9 COLOR
WHITE
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED/DOVED
10a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
EDWARD
SNOW
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
-
(b)
Due To Senility
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed ?
NO
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased? No
If so, specify
(Signed)
H. B. Greenfield
M. D.
PARENTS
21 Informant DONALD SNOW
(Address)
SY COTTAGE AVE WINTHROP
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial 'or transit. permit was issued: Halkla. Spreaune 1
(Signature of Agent of Board of Health/or other)
Reallte Officer
6/1/60
(Official Designation)
(Date of Issue of Permit)
R-301A 1
CTIONS IR ERTIFICATE
ving F DEATH enter tan one or each ) and (c)
s not mean h of dying, bort failure, . It means sv or compli- mch caused
o if any, Le rise to ase (a), e under- Lise last.
uns contrib- ath but not te terminal osition given
( apter 137, 19 .. requires n:o print or e cause or of death on rt cates, and Acts of ques Physi- pat or type de signature.
-6 -- 92 5686
Registered No.
CHIOT HOVED AT !!
SNOW
PHYSICIAN - IMPORTANT f(Was deceased a U. S. War Veteran, (if so specify WAR) NO
DEATH
may
19.
(Give maiden name of wife in full)
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
Congestive heart failure
(a)
H.B. Greenfield
44-15881
(PRINT OR TYPE SIGNATURE)
(State or country) ME
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 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 un- related 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 occu- pation, 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 impor- tant, 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. Chil- dren 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.
JUN -11 1960
R-301A -
ICTIONS OR ERTIFICATE
iving F DEATH r: enter han one e or each ) and (c)
dis not mean d of dying, art failure, . It means 13 or compli- rich
caused
ic, if any, L'e rise to use (a), e under- use last.
dins contrib- c:th but not o he terminal ro ition given
apter 137, !! 1. requires anto print or he cause or o death on eri cates, and ·
Acts of qres Physi- Ent or type drsignature.
1 1960
1-6 -925686
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town)
The Commonwealth of Massachusetts JOSEPH D WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS 1 3
STANDARD CERTIFICATE OF DEATH
Registered No?
127
St. } give its NAME instead of street and numher)
No.
Winthrop .... Community Hospital
2 FULL NAME
Lester Thayer
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
319 Bowdoin Street
(Usual place of abode)
....... St.
(If nonresident, give city or town and State)
Length of stay: In place of death.
. ... years ......
. months10 days. In place of residence 4.8 ... years.
.. months.
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
MAY
30
1960
(Month)
(Day)
(Year)
4 I HEREBY
CERTIFY
Fel.
19.
to ...
58
MAY
60
I last saw h.//halive on
have occurred on the date stated above, at ....
12 SEP
m.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
UREMIA
Due To REPARO-SCLEROSIS T
1/2YRS.
(b)
PROSTATIC HYPERTROPHY WITH
OBSTRUCTION
Due To
GENERAL ARTERIOSCLEROSIS
(c)
* ARTERIO-SCLERITIC HEART DIS
OTHER
SIGNIFICANT
CONDITIONS
NINE
Was autopsy performed?
NO.
What test confirmed diagnosis ?
CLINICAL
5 Was disease or injury in any way related to occupation of deceased 00 If so, specify
(Signed)
MYRON NO.KING MID
(PRINT OR TYPE SIGNATURE)
(Address) 222 PLEASANT ST WINTHROP Date.
6 Wyoming Cemetery Melrose, Mass. Place of Burial or Cremation (City or Town)
DATE OF BURIAL June 2, 1960) 1.
7 NAME OF
FUNERAL DIRECTOR
Glbred B. March
ADDRESS 174 Winthrop St. Winthrop,
6-1-60 -19-
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
male
white
9 COLOR
10 SINGLE
(write the word)
married
MARRIED
WIDOWED
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of Mary Genevive Lowther
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE ... 89 Years
9
.Months
2.3
Days
If under 24 hours
Hours ......
.. Minutes
13 Usual
Occupation: retired mechanic
(Kind of work done during most of working life)
14 Industry
Forbes Lithograph Co.
or Business :
15 Social Security No.
031-10-8742-A.
16 BIRTHPLACE (City)
Boston
(State or country)
Massachusetts
17 NAME OF
FATHER Walter Balfour Thayer
18 BIRTHPLACE OF
FATHER (City)
Boston
(State or country)
Massachusetts
19 MAIDEN NAME
M. D.
OF MOTHER
Florence Choate Knapp
20 BIRTHPLACE OF
Boston
19 5/30 60 MOTHER (City) (State or country) Massachusetts
Mrs. Lester Thayer
21
Informant
(Address)
319 Bowdoin Street, Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the bunal or transit permit was issued!
Mass.
Galple pireanne
(Signature of Agent of Board of Health or other)
Healthe Officer
6/1/60
(Official Designation) (Date of Issue of Permik)
1
To be filed for burial permit with Board of Health or its ' Agent.
f(If death occurred in a hospital or institution,
PHYSICIAN - IMPORTANT [(Was deceased a U. S. War Veteran, {if so specify WAR)
That I attended deceased from
30
30
death is said to
INTERVAL
BETWEEN
ONSET AND
DEATH
4 arts.
ILYKS
PARENTS
Received and filed
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 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 lasf illness from disease un- related 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 certily for 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 occu- pation, 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 impor - tant, 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. Chil- dren 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.
RM R-302
1
PLACE OF DEATH
Middlesex
14/ 15 N &
Everett
(City or Town)
The Commonwealth of Massachusetts EVERETT JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
(City or Town making this return)
217 128
§ (If death occurred in a hospital or institution, .. St. ¿ give its NAME instead of street and number)
2 FULL NAME.
Gyrdie Willie Dickinson M.D.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
89 Somerset Avenue
S
( If nonresident, give city or town and State)
Length of stay: In place of death .......... years ..
3
.months.
7
.days. In place of residence.
.. years.
41
.months ...
.... days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
Wht.
10 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCED
Married
4 I HEREBY CERTIFY.
That I attended deceased from
May .... 29
60
19
I last saw
himalive on
57
5/29/
160
., death is said to
10a If married, widowed, or divorced
Mary Elizabeth Cronin
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
AG
84
Years.
3 .. Months.
10 Days
If under 24 hours
Hours ........ Minutes
13 Usual
Medical Physician
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business :
Self Employed
15 Social Security No.
none
16 BIRTHPLACE (City)
(State or country)
Fairfield, Vermont
17 NAME OF
FATHER
Byron Dickinson
18 BIRTHPLACE OF
FATHER (City)
(State or country )
Underhill, Vermont
no
( Signed )
Peter Sapienza
M. D.
(Address )
6 Appleton St.,
.... Date
5/3//1960
Puritan Lawn, W. Peabody, Mass. 6
DATE OF BURIAL
June 1,
60
19
21
Mrs. Gyrdie W. Dickinson
Informant
(Address) 09 Somerset Av., Winthrop
7 NAME OF FUNERAL DIRECTOR Alfred .B ..... Marsh
ADDRESS
174 Winthrop St. Winthrop
JUNE 221 60
Received and filed
( Registrar of City or Town where deceased resided)
PARENTS
19 MAIDEN NAME
OF MOTHER
Edna Kittell
20 BIRTHPLACE OF
MOTHER (City)
Franklin County
( State or country )
Vermont
A TRUE COPY
ATTEST :
(Registrar of City or Town where death occurred)
DATE FILED
6/17/'60
50M-9-59-926111
at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town Due To (c)
THIS IS A PERMANENT RECORD
WRITMIDI ATM
Whidden Hospital No. (a) Residence. No ( Usual place of abode) MEDICAL CERTIFICATE OF DEATH 3 DATE OF May DEATH (Month) (Day) (Year) 60 to ...... 2:30P have occurred on the date stated above, at .m. DEATH WAS CAUSED BY: IMMEDIATE CAUSE (a) Arteriosclerotic Heart Disease Due To Generalized (b) Atheromatosis OTHER SIGNIFICANT CONDITIONS Was autopsy performed? No 5 Was disease or injury in any way related to occupation of deceased ? If so, specify Mal: (City or Town) Place of Burial or Cremation resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12. G. L.) What test confirmed diagnosis ? Clinical Exam.
INTERVAL BETWEEN ONSET AND DEATH
yrs.& days.
years
29,
1960
( Was deceased a
U. S. War Veteran.
No
(if so specify WAR, ..
Winthrop, Massachusetts
Registered No.
(County)
WINTHROP. NO
JUN 2 21960 AM
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER
de
T
ts
X PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Town) 120 Sargent
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
Registered No.
129
§(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number) No.
2 FULL NAME
Catherine J. Allen (casey)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
120 Sargent
St.
Winthrop
(a) Residence. No.
(Usual place of abode)
5
5
(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
3 DATE OF
June 8, , 1960
DEATH
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
Nov
19.5.2 .. ,
to ..
vune
8
60
I last saw hey.alive on
June 8
19 .... , death is said to
have occurred on the date stated above, at .
1:45 p.m.
INTERVAL
BETWEEN
ONSET AND
DEATH
5yrs
1 day
Due To
(c)
OTHER
SIGNIFICANT
CONDITIONS
None
Was autopsy performed?
No
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.
(PRINT QR TYPE SIGNATURE)
(Address)
238
Winthrop Sh . Date
Dr. 6/8 1.60
Lakeview Cemetery, Burlington, Vt Place of Burial or Cremation (City or Town)
DATE OF BURIAL
.J.une .....
.... l.,
19 .. 6€
7 NAME OF
FUNERAL DIRECTOR
Alfred B. Marsh
ADDRESS 174 Winthrop St., Winthrop
Received and filed 19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
female
9 COLOR
white
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
widowed
10a If married, widowed, or divorced
HUSBAND of
George E. Allen
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
87
10
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 :
At home
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Vermont
17 NAME OF
FATHER
Patrick Casey
18 BIRTHPLACE OF
Information unavailable
FATHER (City)
(State or country)
19 MAIDEN NAME
M. D.
OF MOTHER
Information unavailable
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Mrs. Ethel Moran
21
Informant
(Address)
120 Sargent St., Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: PalliE- Serianni (Signature of Agent of Board of Health or other) June 8, 1960
......... (Official Designation)
(Date of Issue of Permit)
CTIONS R
ERTIFICATE
ving DEATH enter an one r each ) and (c)
not mean of dying, ut failure, It means stor compli- och caused
or if any, gee rise to se (a), : under- se last.
itis contrib- dith but not e terminal ontion given
Capter 137, 9. requires mo print or c cause or o death on cates, and Acts of ques Physi- Pit or type d ignature.
6 925686
R-301A 1
To be filed for burial permit with Board of Health or its Agent.
PHYSICIAN - IMPORTANT
[(Was deceased a
U. S. War Veteran,
no
{if so specify WAR)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Cerebral Arteriosclerosis
Cerebral Vascular
Due
(b)
Occlusion.
Jericho
PARENTS
Information unavailable
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 following rules of practice : (1) Attending physicians will certify to such deaths only as those of persons - 1960 A to whom they have given bedside care during a last illness from disease un. related 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 occu- pation, 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 impor- tant, 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. Chil- dren 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.
PLACE OF DEATH
SUFFOLK
(County) WINTHROP (City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH To be filed for burial permit with Board of Health or its Agent. DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH Registered No. 130
En route to Winthrop Community Hospital {(If death occurred in a hospital or institution, No.
St. ¿ give its NAME instead of street and number)
2 FULL NAME
SARAH
BOUDREAU
(
Power)
PHYSICIAN - IMPORTANT
(Was deceased a
(If deceased is a married, widowed or divorced woman, give also maiden name.)
U. S. War Veteran,
(if so specify WAR).
No
(a) Residence. No.
430 Revere Street, Winthrop
St
(If nonresident, give city or town and State)
Length of stay : In place of death ............. years ............ months .............
.days. In place of residence ... ].7 .... years.
... months .....
.days.
PERSONAL AND STATISTICAL PARTICULARS
9 SEX
10 COLOR
White
11 SINGLE
MARRIED
WIDOWED
or DIVORCEDMarried
(write the word)
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.) Hypertensive cardiovascular disease.
11a If married, widowed, or divorced HUSBAND of (Give maiden name of wife in full)
(or) WIFE of
Ernest R. Boudreau
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
13
AGE56
8
Years.
Months.
11
Days
Hours
Minutes
14 Usual
Occupation :
Housewife
(Kind of work done during most of working life)
15 Industry
or Business :
16 Social Security
029-12-2603
Boston
17 BIRTHPLACE (City)
(State or country)
Nass
18 NAME OF
FATHER
Michael Power
19 BIRTHPLACE OF
FATHER (City)
(State or country)
Newfoundland
20 MAIDEN NAME
OF MOTHER
Ellen
not known
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
Boston
Mass
22 Informant (Address) 430 Revero St.Winthrop, Mass.
Ernest. ... R. Boudreau
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)
(Official Designation)
(Date of Issue of Permit) VBV
DEATH in plain terms, so that it may be properly classified under the International Classification of Causes §§ 44-48. WHILELAINLL WITH UNFADINGALL of Death. See reverse side for additional information. See also Chap. 38, §§ 6, 20; Chap. 46, §§ 9, 10; Chap. 114, Injury (How did injury occur ?)
Did injury occur in or about home, on farm, in industrial place, or in
public place ?
(Specify type of place)
While at work ?
.. Was autopsy performed?
No
6 Was disease or injury in any way related to occupation of deceased ?
M. D.
(Address)
Date
6/9
1660
7 Winthrop
Winthrop
Place of Burial, or Cremation.
(City or Town)
DATE OF BURIAL .June 13 ,1960 19.
8 NAME OF
FUNERAL DIRECTOR Arthur ... S ..... Porcella
ADDRESS 876 Winthrop Ave., Revere, Mass.
Received and filed
JUN 13 1960
19
PARENTS
35M-11-59-926662
.
5
R-303 A 1
(Usual place of abode)
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
June
9,
1960
(Month)
(Day)
(Year)
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)
Manner of
Nature of
Injury
Boston
(Print or Type Signature)
If deceased was a U. S. War Veteran, G.L. Chap. 46, Section 10, requires physicians to insert a recital to that effect.
If
What thongs
Michael A. Luongo, M.D.
Female
If under 24 hours
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 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 administered as a surgical anaesthetic for (enter name of operation and disease or condition requiring surgery)." "Fracture of the skull with associated internal injury sustained under circumstances unknown."
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