USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1960 > Part 48
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as soon as possible after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) the time of death should be transmitted on Form R-305 to the clerk of the city or town in which the deceased resided
25M-4-59-925100
PLACE OF DEATH
MIDDLESEX
(County) STONEHAM
(City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
STONCHAM
(City or town making return)
Registered No.
219
S(If death occurred in a hospital or institution,
St. ¿ give its NAME instead of street and number)
2 FULL NAME
willis GeorgeCarsley
(If deceased is a married, widowed or divorced woman, give also maiden name.)
65 Sargent
St
Winthrop
(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.
35
.. years .............. months.
.........
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
October 8, 1960
(Month)
(Day)
(Year)
9 SEX
Male
10 COLOR
White
MARRIED
WIDOWED
or DIVORCED
Single
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.)
lla 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.
Months.
24
.Days
If under 24 hours
.Hours.
.Minutes
5 Accident, suicide, or homicide (specify)
No
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 ?
Manner of
Injury
(How did injury occur ?)
Nature of
Injury
While at work ?
No
.. Was autopsy performed? No
Ro
6 Was disease or injury in any way related to occupation of deceased ?
If so, specify
(Signed)
Thomas P. Devlin
M. D.
(Address)
Stoneham, Mass.
Date.
10/8/ 10 60
7
Winthrop Cemetery Winthrop, Mass.
Place of Burial, or Cremation.
(City or Town)
DATE OF BURIAL
October 11, 1960
19
8 NAME OF
FUNERAL DIRECTOR
Alfred B. Marsh
ADDRESS
174 Winthrop St.
Winthrop
Received and filed
0C 114960
19
PARENTS
21 BIRTHPLACE OF
Winthrop
MOTHER (City)
(State or country)
Mass.
22
Geraldine Carsley
Informant
(Address)
262 Adans St. No. Abbington
A TRUE COPY. . /
2. catch
ATTEST:
DATE FILED
(Registrar of City or Town where death occurred)
October 10
1
60
19.
-
7)
(Registrar of City or Town where deceased resided)
17 BIRTHPLACE (City)
(State or country)
16 Social Security No.
Winthrop,
Mass.
18 NAME OF
FATHER
Hillis Elwood Carsley
19 BIRTHPLACE OF
Harrison
FATHER (City)
(State or country)
flaine
20 MAIDEN NAME
OF MOTHER
Ida Louise Phillips
Retired Accountant
14 Usual
Occupation :
(Kind of work done during most of working life)
15 Industry
or Business :
Bethlehem Steel Co.
011-03-2384
Heart Disease-presumably coronary sclerosis - Sudden Death
49
3
11 SINGLE
(write the word)
[(Was deceased a
U. S. War Veteran,
II
{if so specify WAR)
Tennis Court-Pomeworth
No.
.
(Specify type of place)
RECEIVED
TOW,1
20 301990
11 12. 1
CLERK
351
6
IS IN
R
SPACE FOR ADDITIONAL INFORMATION
OCJ. 111960 AH ..
DATE OF ENTERING MILITARY SERVICE
28, ... 1941
DATE OF DISCHARGE
September 27, 1943
RANK, RATING
Corporal
ORGANIZATION AND OUTFIT
4th Service Command
SERVICE NUMBER
31018452
....
-
ORM R-304
PLACE OF DELIVERY No.
SUFFOLK (County)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS CERTIFICATE OF FETAL DEATH ( STILLBIRTH)
To be filed for burial permit with Board of Health or its Agent.
Registered No.
220
(If death occurred in a hospital or institution, give its NAME instead of street and number)
3 DATE OF
DELIVERY
10/11/60
(Month)
( Day)
(Year)
4 SEX
Malex
.. Female ...... Undetermined .. ..
5 COLOR (if
determined ) ..
W
6 THIS BIRTH (Check one)
Single. X . . Twin .. .
Triplet.
7 IF MULTIPLE BIRTH, BORN :
1st ..
.. 2nd
.. 3rd
FATHER
MOTHER
MAIDEN NAM
Edith Purciello
PRESENT NAME
Edith Riccio
9 RESIDENCE, NO.
6 Leahaven Terr.
STREET
CITY OR TOWN
S. Braintree , STATE Mass.
RESIDENCE, NO.
CITY OR TOWN
S. Braintree , STATE Mass.
10 COLOR OR
RACE
11 AGE AT TIME OF THIS DELIVERY 38 .(Years)
16 COLOR OR
RACE .
W
17 AGE AT TIME OF
THIS DELIVERY
3.7 ... (Years)
12 PLACE OF
BIRTH
Boston, Mass.
(City or Town)
(State or country)
18 PLACE OF
BIRTH
Boston, Mass.
(City or Town)
(State or country)
13
OCCUPATION
School Teacher
19 INFORMANT Mother
20 PREVIOUS DELIVERIES TO MOTHER
(Do not include this fetus)
One
(a) How many children are
now living?
(b) How many children were
born alive but are now
dead ?
(c) How many previous fetal deaths of ANY gestation age?
21 LENGTH OF
PREGNANCY
330 completed
weeks
22 WEIGHT OF FETUS
Lb. 14 Oz.
23 WHEN DID FETUS DIE?
Before
Labor
24 AUTOPSY
Yes
No
25 FETAL DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a) .
Due To (b) Due To (c)
OTHER SIGNIFICANT CONDITIONS
26 Place of Burial or Cremation
(City or Town) 19
DATE OF BURIAL .
27 NAME OF FUNERAL DIRECTOR ADDRESS
Received and filed 19
A TRUE COPY ATTEST :
I HEREBY CERTIFY that this delivery occurred on the date stated above at 35 P.m., and product of conception was not a live birth.
Signature of Attending Physician or Medical Examiner :
M.D.
John D Laterella MD (PRINT OR TYPE SIGNATURE)
Address 505 Chelsea St E.B
MASS
Date 10/11 1960
I HEREBY CERTIFY that a satisfactory certificate of fetal 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)
In giving CAUSE OF ETAL DEATH
do not enter more than one cause for each of (a), (b) and (c)
tal or maternal ndition causing tal death (do ot use such ms as stillbirth prematurity. ) tal and/or ma- nal conditions, any, which gave se to above ase (a), stating le underlying rise last.
nditions of fetus mother which y have contrib- ed to fetal ath, but, in so as is known, re not related cause given (a).
5M-6 - 60-928241
1
Winthrop (City or Town )
Winthrop Community Hospital
St.
-
2 NAME OF FETUS (if given)
(Registrar)
During Labor
or Delivery.
Unknown
(or
.Grams )
15
6 Leahaven Terr.
STREET
8
FULL
NAME
John Riccio
L
-
FETAL DEATH
EXTRACTS OF CERTAIN SECTIONS OF CHAPTER 46 AS AMENDED OR ADDED BY CHAPTER 48. ACTS OF 1960.
Section 2A. "Examination of records and returns of illegitimate births, or abnormal sex births, or fetal deaths, .. . shall not be permitted except ... ".
Section 9A. When a child is born dead, after a period of gestation of not less than twenty weeks, and in the fetus there is no attempt at respiration, no action of heart and no movement of voluntary muscle, the physician or officer attending at the birth of such child shall forthwith furnish for registration, at the request of an undertaker or other authorized person or of any member of the family of the deceased, a certificate of fetal death on a form which shall be prepared by the secretary of state as required by section sixteen. Town clerks shall record certificates of fetal death in the town register of deaths in the same manner as a death certificate, but they shall not be required to record such certificates in the town register of births.
Section 12. ". .. No birth record of a child born out of wedlock or of a child of abnormal sex, and no record of fetal death shall so be transmitted to any other city or town."
Section 24. In any statement of births, deaths and fetal deaths printed by a town the name of an illegitimate child or of its parents or of the parents of a child born dead shall not be printed, but the word "illegitimate" or "fetal death" shall be used in place thereof. A town violating this section shall forfeit to the mother of such child not more than one hundred dollars.
RECEIVED
FETAL DEATH
OF TOWA 11 12 1 1,
EXTRACTS OF CERTAIN SECTIONS OF CHAPTER 46 AS AMENDED OR ADDED BY CHAPTER 48, ACTS OF 1960.
OFFIC
ERK
Section 2A. "Examination of records and returns of illegitimate births, or abnormal sex births, or fetal deaths, . .. shall not be permitted except .. . ". 7 62
IT
Section 9A. When a child is born dead, after a period of gestation of not less than twenty weeks, and in the fetus there is no attempt at respiration, no action of heart and no movement of voluntary muscle, the physician or officer attending at the birth of such child shall forthwith furnish for registration, at the request of an undertaker or other authorized person or of any member of the family of the deceased, a certificate of fetal death on a form which shall be prepared by the secretary of state as required by section sixteen. Town clerks shall record certificates of fetal death in the town register of deaths in the same manner as a death certificate, but they shall not be required to record such certificates in the town register of births.
Section 12. ". .. No birth record of a child born out of wedlock or of a child of abnormal sex, and no record of fetal death shall so be transmitted to any other city or town."
Section 24. In any statement of births, deaths and fetal deaths printed by a town the name of an illegitimate child or of its parents or of the parents of a child born dead shall not be printed, but the word "illegitimate" or "fetal death" shall be used in place thereof. A town violating this section shall forfeit to the mother of such child not more than one hundred dollars.
FORM R-304 X
PLACE OF DELIVERY No.
Suffolk (County )
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS CERTIFICATE OF FETAL DEATH ( STILLBIRTH)
To be filed for burial permit Board of Health or its Agent.
Registered No.
(If death occurred in a hospital or instit give its NAME instead of street and nur
3 DATE OF DELIVERY Oct. 11
( Month )
(Day)
4 SEX
*
Male .. ... Female .. . Undetermined.
5 COLOR (if
determined). w
6 THIS BIRTH (Check one) Single. .. .. .Twin .... .Triplet
7 IF MULTIPLE BIRTH, BC
1st. . ... 2nd
. . 3rd ..
FATHER
MOTHER
14
MAIDEN NAME
Edith (Riccio) Purciello
PRESENT NAME
Edith Riccio
9 RESIDENCE, NO.
6 Leahaven Terrace
CITY OR TOWN
South Braintree
STATE
STREET
Mass
15
RESIDENCE, NO.
STF
6 Leahaven Terrace
CITY OR TOWN South Braintree
STATENASS
10 COLOR
RACE
ARite
11 AGE AT TIME OF
THIS DELIVERY
35 (Years)
16 COLOR ORhite RACE.
17 AGE AT TIME OF
THIS DELIVERY
33
12 PLACE OF
BIRTH
Boston Mass
Boston
Mass.
(City or Town)
(State or country)
(City or Town)
(State or country)
13 School Teacher
19 INFORMANT John Riccio
(father)
20 PREVIOUS DELIVERIES TO MOTHER (Do not include this fetus)
(a) How many children are
now living?
(b) How many children were
born alive but are now
dead?
(c) How many previous deaths of ANY ges! age?
21 LENGTH OF
PREGNANCY
22 WEIGHT OF FETUS Lb.
Oz.
completed
weeks
(or ...
Grams)
23 WHEN DID FETUS DIE? Before Labor
During Labor
or Delivery. ...
Unknown.
24 AUTOPSY
Yes
.No
25 FETAL DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Due To (b) Still Born
Due To (c)
OTHER SIGNIFICANT CONDITIONS
26 Holy Cross Cemetery Place of Burial or Cremation
Malden, Mass (City or Town)
DATE OF BURIAL
October
14
27 NAME OF
FUNERAL DIRECTOR
Anthony P. Rapino
ADDRESS 9 Chelsea St. East Boston, Mass
Received and filed OCT 13 1960 19
(Registrar )
A TRUE COPY ATTEST :
I HEREBY CERTIFY that this delivery occurred on the date ! above at 828 m., and product of conception was not a live
Signature of Attending Physician or Medical Examiner :
John D Lator
lla na (PRINT OR TYPE SIGNATURE)
Address
305 Chelsea St. E.B. Date11-13
I HEREBY CERTIFY that a satisfactory certificate of fetal was filed with me BEFORE the burial or transit permit was i!
Halkle EnSirians (Signature of Agent of Board of Health or other) Healthe Officer (Official Designation )V
10/13/6
(Date of Issue of Permit) 1
Fetal or maternal condition causing fetal death (do not use such terms as stillbirth or prematurity.) Fetal and/or ma- ternal conditions, if any, which gave rise to above cause (a), stating the underlying cause last.
Conditions of fetus or mother which may have contrib- uted to fetal death, but, in so far as is known, were not related to cause given in (a).
5M-6-60-928241
1
Winthrop (City or Town)
Winthrop Community Hospital
St.
2 NAME OF FETUS (if given)
Baby Boy Riccio
196c
8 FULL NAME
John Riccio
In giving CAUSE OF FETAL DEATH do not enter more than one cause for each of (a), (b) and (c)
OCCUPATION
18 PLACE OF
BIRTH
19 60
M R-301A
TRUCTIONS FOR L CERTIFICATE
JURISDICTION
1 giving OF DEATH not enter than one e for each (b) and (c)
does not mean de of dying, heart failure, etc. It means se, or compli- which caused
ions, if any, gave rise to cause (a), the under- cause last.
litions contrib- death but not o the terminal ondition given
Chapter 137, 1954. requires ns to print or e cause
or of death on rtificates, and 48, Acts of quires Physi- print or type der signature. 1.5.
16-59-925686
× 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
STANDARD CERTIFICATE OF DEATH
Registered No.
221
2 FULL NAME
Josephine M. Fay ( liveiros)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
207 Pleasant St. Winthrop
St.
(Usual place of abode)
(If nonresident, give city or town and State)
4
Length of stay: In place of death.
... years ...
........... months.
1
.days. In place of residence.
... years ..
.months ..........
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
3 DATE OF
DEATH
OCT
14
1960
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY , That I attended deceased from
JAN
19.
to .....
...
I last saw het Malive on
10/14
death is said to
have occurred on the date stated above, at
500 Am.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
ACUTE PULMONARY EDEMA
(a) .....
Due To HYPERTENSIVE & ARTERIO- (b) .... SCLEROTIC HEART DIS.
5 YRS
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
CHRONIC BRONCHITIS
2YRS. 5YRS
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 ...
Myron h. Ting
(Signed)
......
MYRON UN. KING M.G
(PRINT OR TYPE SIGNATURE)
(Address) 222 PLEASANT ST WINTERIN Date
winthrop Cemetery Winthrop 6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
October 17th
19 60
7 NAME OF
Richard C. Kirby, Inc.
ADDRESS 17 Bennington St., E. Boston
Received and filed OCT 17 1960 .. 19
(Registrar)
PARENTS
M. D.
OF MOTHER
Anna Vieria
20 BIRTHPLACE OF
Azores
MOTHER (City)
(State or country)
Portugal
21 Mrs. Margaret Feeck-sister
Informant (Address) 90 Florida St. Dorchester
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)
10/14 60
(Official Designation)
(Date of Issue of Permit) 6,
MARRIED
WIDOWED
or DIVORCEDWidowed
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Bernard ray
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 77 Years.
........... Months ..
7 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. None
16 BIRTHPLACE (City)
Boston
(State or country)
Massachusetts
17 NAME OF
FATHER
Manuel Viveiros
18 BIRTHPLACE OF
FATHER (City)
Azores
(State or country)
Portugal
19 MAIDEN NAME
10/14
1960
To be filed for burial permit with Board of Health or its Agent.
Winthrop Community Hospital No.
S(If death occurred in a hospital or institution,
St. Į give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
[(Was deceased a
U. S. War Veteran,
(if so specify WAR)
No
58,
Oct 14 .1960
60
INTERVAL BETWEEN ONSET AND
DEATH
12 hrs
MEDICAL EXAMINER DECHINE)
DIABETES MELLITUS
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
RECEIVED
DATE OF DISCHARGE
L'AF TOWN 11 12
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
6 0
RULES OF PRACTICE
OCT 1 71960 AM
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.
20
ERK
1
1 R-301A 1
RUCTIONS FOR . CERTIFICATE
giving OF DEATH
not enter : than one for each (b) and (c)
loes not mean le of dying, heart failure, etc. It means se, or compli- which caused
ons, if any, gave rise to cause (a), the under- cause last.
itions contrib- death but not the terminal ondition given
Chapter 137, 954. requires ns to print or e
cause or of death on tificates, and 48, Acts of quires Physi- print or type der signature.
5-59-925686
PLACE OF DEATH
SuffoLK INSE PITTY (County) WINTHROP (City or Town) WINTHROP COMMUNITY HOSPITAL No.
CERTIFICATE OF DEATH
Registered No.
2 hospit f death occurred i give its NAME instead of street and number)
& FULL NAME ARTHUR S TEWKSBURY
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 52 Waldemar Ave.
St.
(If nonresident, give city or town and State)
Length of stay: In place of death. ears ..
.. months. 15 days. In place of residence. 88
... years 5
26
months
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
October
/15
1960
(Month)
(Day)
(Year)
oct. 1
CERTIFY,
60
October 15
60
I last saw hlalive on
October ..... 15, 19.60, death is said to
have occurred on the date stated above, at
9:45 PM
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
88
AGE
Years.
5
Months
26
Days
If under 24 hours
Hours ...
......
.Minutes
13 Usual
Occupation :
Superintendent buildings
(Kind of work done during most of working life)
14 Industry
or Business:
School
Retired
15 Social Security No.
none
16 BIRTHPLACE (City)
(State or country)
Mass
17 NAME OF
FATHER
John Tewksbury
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Mass
Winthrop
19 MAIDEN NAME
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Nova Scotia
Informant 21 Arthur S Tewksbury Ir (Address)447 Main St. Lynfield Mass
I HEREBY CERTIFY that a satisfactory standard certificate of death
was, filed with me BEFORE the burial or transit permit was issued:
Para
-terrains 4
(Signature of Agent of Board of Health, or other)
10/17/60
(Official Designation) V V
(Date of Issue of Permit)
(Registrar)
PARENTS
Winthrop
Winthrop
6
Place of Burial or Cremation
DATE OF BURIAL
Oct.
"figy or Town)
.60
19
7 NAME OF
FUNERAL DIRECTOR
Howard S Reynolds
ADDRESS Winthrop,Mass
Received and filed OCT 17 1960 19
3 yrs
Due To (c)
OTHER
Arterio-sclerotic
SIGNIFICANT
CONDITIONS
heart disease
3 yrs
Was autopsy performed?
NO
What test confirmed diagnosis ?
Clinical and Lab,
5 Was disease or injury in any way related to occupation of deceased ? If so, specify.
NO
(Signed)
In. Trausetzen
M. D.
OF MOTHER
Caroline Banks
M ....... Traunstein .... J.r ...... M.D ...
(PRINT OR TYPE SIGNATURE)
73 Bartlett Rd . Date ...
Oct. 15,60
(Address)
to
19
10a If married, widowgh of divorced Aikens
HUSBAND of
(Give maiden name of wife in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Left Cerebral Hemorrhage
(a)
with right Hemiplegia
INTERVAL
BETWEEN
ONSET AND
DEATH
2 wks
Due ToGeneralized and Cerebral (b)
Arterio-sclerosis
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
To be filed for burial permit with Board of Health or its Agent.
222
PHYSICIAN - IMPORTANT [(Was deceased a U. S. War Veteran, [if so specify WAR)
(Usual place of abode)
That I attended deceased from
(write the word)
10 SINGLE
MARRIED
WIDOWED
or DIVORCED Widow a
8 SEX
Male
9 COLOR
White
Winthrop
RECE VED
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
ERK
3
1 1
THROP MASS.
OCT 1-7-1960 AM
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.
PLACE OF DEATH
Suffolk
(County)
Winthrop
(City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
Registered No.
223
S(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
2 FULL NAME
Philip Boudrow
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
24 Franklin St ....
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death .............. years. months 4 days. In place of residence. ........... years ... .. months ..... ....... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
OCT
16
1960
(Year)
(Month)
(Day)
That I attended deceased from
19.
death is said to
have occurred on the date stated above, at
11 22/m.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
QCUTE POSTERIOR MYOCARDIAL
(a)
INFARCTION
INTERVAL BETWEEN ONSET AND DEATH 4 DAYS
Due To (b)
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
NONE
Was autopsy performed?
No
What test confirmed diagnosis? CLINICALSERG
5 Was disease or injury in any way related to occupation of deceased? 10 If so, specify
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