Town of Winthrop : Record of Deaths 1961, Part 33

Author: Winthrop (Mass.)
Publication date: 1961
Publisher:
Number of Pages: 542


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 33


Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).


Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39 | Part 40 | Part 41 | Part 42 | Part 43 | Part 44 | Part 45 | Part 46 | Part 47 | Part 48 | Part 49 | Part 50 | Part 51


(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.


2


6 5


X PLACE OF DEATH


Suffolk (County)


Winthrop (City or Town)


No. 12 Cherry Street


The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS


STANDARD CERTIFICATE OF DEATH


166


[(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)


PHYSICIAN - IMPORTANT


2 FULL NAME William Walton Sterndale (First Name) ( Middle Name) (Last Name)


(1f deceased is a married, widowed or divorced woman, give also maiden name.)


(a) Residence. No.


(Usual place of abode)


Length of stay: In place of death.


19


years


months.


days. In place of residence.


19years


.. months.


... days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


September


7


1961


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY,


That I attended deceased from


June .8,


19 .. 61


to.


September 7 . ....... , 19 61


I last saw h. ... "alive on September 7, 1961, death is said to have occurred on the date stated above, at 6:50 P .... m.


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


bronchogenic carcinoma right


(a) Jung


INTERVAL BETWEEN ONSET AND DEATH 3 mos


Due To (b)


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


none


Was autopsy performed?


no


What test confirmed diagnosis?


Clinical & Laboratory


5 Was disease or injury in any way related to occupation of deceased? no. If so, specify


(Signed)


MaTraundian


Traunstein, Jr. , / M. D.


(Address)


(PRINT OR TYPE SIGNATURE) 73 Bartlett Rd


Date Sept. 821961


Winthrop 52, Mass


Elmwood Cemetery Methuen, Mass. 6


Place of Burial or Cremation (City or Town)


DATE OF BURIAL September 11, 1961 19


7 NAME OF


FUNERAL


DIRECTOR alfred 13 Marsh


ADDRESS


174 Winthrop St. Winthrop,


Received and filed


1-8-61


19


(Registrar)


PERSONAL AND STATISTICAL PARTICULARS


8 SEX male


9 COLOR


white


10 SINGLE


(write the word)


MARRIED


married


WIDOWED


or DIVORCED


HUSBAND of


10a If married, widowed, or divorced,


Teresa Gilmartin


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE.


64 Years 2 Months.


0


... Days


lf under 24 hours


Hours.


Minutes


13 Usual


OccupationVOO1 grader


(Kind of work done during most of working life)


14 Industry


or Business :


wholesale wool sales


15 Social Security No.


025-07-9330


16 BIRTHPLACE (City)


Lancaster


(State or country)


England


17 NAME OF


FATHER


John James Sterndale


18 BIRTHPLACE OF


FATHER (City)


Lancaster


M. D


(State or country)


England


19 MAIDEN NAME


OF MOTHER


Jane Elizabeth Walton


20 BIRTHPLACE OF


MOTHER (City)


Lancaster


(State or country)


England


21


Informant


Mrs.


William W. Sterndale


....


(Address)


12 Cherry St. Winthrop, Mass.


lass.


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Kalkle 2. J ercan (Signature of Agent of Board of Health or other) 91.0 Wealth Chick 9/8/6/ 1


Il (Official Designation)


(Date of Issue of Permit)


L


R-301A 1


UCTIONS FOR CERTIFICATE


giving OF DEATH t enter than one for each b) and (c)


es not mean of dying, eart failure, tc. It means ,. or compli- hich caused


as, if any, ve rise to ause (a), the under- ause last.


ions contrib- eath but not the terminal dition given


C.


Chapter 137, 1954. requires ns to print or le cause or of death on rtificates, and 48, Acts of quires Physi- print or type der signature.


PARENTS


{ (Was deceased a U. S. War Veteran,


[if so specify WAR)


NO ..


12 Cherry Street


St.


(If nonresident, give city or town and State)


To be filed for burial permit with Board of Health or its Agent.


Registered No.


.928145


-


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.


FY


X


PLACE OF DEATH


Suffolk (County)


Winthrop


(City or Town) Winthrop Community Hospital


The Commonwealth of Massachusetts JOSEPH D. WARD 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


[ (Was deceased a


U. S. War Veteran,


No


[if so specify WAR)


280 River Road


(a) Residence. No. . (Usual place of abode)


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)


Married


MARRIED


WIDOWED


or DIVORCED


10a If married, widowed, or divorced HUSBAND of


(or) WIFE of


Myer Cohen


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE


Years


Months.


Days


23


If under 24 hours Hours .......... Minutes


13 Usual


Occupation :


(Kind of work done during most of working life)


14 Industry


or Business :


Housewife


15 Social Security No.


none


16 BIRTHPLACE (City) (State or country) "Russia


17 NAME OF FATH Nagarya, Jacob


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Europe


Poland


PARENTS


19 MAIDEN NAME


OF MOTHER


Fanni- (c.b.l.)


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Poland


Europe


21 Informant


Gerald N. Cohen,


3 Wauwinet Road, Newton, Mass.


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Ровки Алешш. ...


(Signature of Agent of Board of Health or ofner) Heable Officer 9/10/6/1


(Official Designation)


(Date of Issue of (Permit)


1. V


UCTIONS FOR CERTIFICATE


giving OF DEATH ot enter than one for each b) and (c)


es not mean of dying, heart failure, tc. It means , or compli- hich caused


ns, if any, ave rise to ause (a), the under- ause last.


tions contrib- eath but not the terminal ndition 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.


(Signed)


MYRON NO KINGMID


(PRINT OR TYPE SIGNATURE)


(Addr 51222 PLEASANT ST WINTHROP Miss Date.


Sharon Memorial Park- Sharon 6


Place of Burial or Cremation


(City or Town)


September 10,


.19


19 61


DATE OF BURIAL


7 NAME OF


FUNERAL DIRECTOR


Torf Funeral Service, Inc (Address)


ADDRESS


1615 Beacon St. Brookline


Received and filed


SEPT: 11. 1961


19


( Registrar)


(Nee Nagarya)


2 FULL NAME


Esther L. Cohen


10


1961


DEATH


(Month)


(Day)


(Year)


4 I HEREBY


TAN


CERTIFY,


That I attended deceased from


1955


to.


SEPT


10


1961


I last saw h.Chalive on


SEPT 10


1961


death is said to


have occurred on the date stated above, at


1215 A


.. m.


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


(a)


UREMIA-


2 DAYS


CEREBRAL VASCULAR ACCT


Due To


(b)


HYPERTENSION and


Due To


(c)


HYPERTENSIVE HEART DIS


10YRS


OTHER


SIGNIFICANT


CONDITIONS


NONVE


Was autopsy performed?


No


What test confirmed diagnosis?


CLINICAL


NO


5 Was disease or injury in any way related to occupation of deceased? If so, specify


M. D


9/10


INTERVAL BETWEEN ONSET AND DEATH 14 DAYS 70


St


(If nonresident, give city or town and State)


3 DATE OF


SEPT


(First Name) (Middle Name) ( If deceased is a married, widowed or divorced woman, give also maiden name.)


(Last Name)


To be filed for burial permit with Board of Health or its Agent.


No.


14


R-301A 1


928145


(Give maiden name of wife in full)


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.


X 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


To be filed for burial permit with Board of Health or its Agent.


(If death occurred in a hospital or institution, St. ( give its NAME instead of street and number)


PHYSICIAN - IMPORTANT


2 FULL NAME Carrie E. Weston (First Name) (Middle Name) (Last Name)


(If deceased is a married, widowed or divorced woman, give also maiden name.)


36 Ingleside Avenue St.


(If nonresident, give city or town and State)


Length of stay: In place of death .__... years months. days. In place of residence 55 years


.. months.


.days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


September


10


1967


(Month)


(Day)


(Year)


8 SEX


female


9 COLOR


white


MARRIED


WIDOWED


or DIVORCED


single


4 I HEREBY CERTIFY,


That I attended deceased from


JANUARY 16


194/9


to ....


SEPTEMBER


10


19


61


I last saw h ....... alive on


SEPTEMBER 9


19.61


, death


said to


have occurred on the date stated above, at


1:30 Am.


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


ACUTE CONGESTIVE HEART FAILURE


(a)


Due To


(b)


ARTERIOSCLEROSIS HEART DISEASE


Due To (c) ARTERIOSCLEROSIS AND HYPERTENSION 12 YRS


OTHER


SIGNIFICANT


CONDITIONS


Was autopsy performed?


No


What test confirmed diagnosis?


5 Was disease or injury in any way related to occupation of deceased? If so, specify


No


(Signed) Dorothy Cheney appleton M. D DOROTHY CHENEY APPLETON (PRINT OR TYPE SIGNATURE)


WINTHROP MASO


6 Winthrop Cemetery, Winthrop, Dass Place of Burial or Cremation (City or Town)


DATE OF BURIAL September 12, 1961


.. 19


7 NAME OF FUNERAL DIRECTOR


ADDRESS


174 Winthrop St. Winthrop,


Received and filed SEP 12 1961 19


(Registrar)


W PARENTS


20 BIRTHPLACE OF


Boonton


MOTHER (City)


(State or country)


New Jersey


/21


Informant


(Address)


Washburn Weston, Ir Schenectady New York


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:


Mass ... Talkle FI ereanne


"(Signature of Agent of Board of Health or other)


Thealth Officer


9/12/61%


(Official Designation)


(Date of Issue of Permit)


928145


R-301A 1


UCTIONS FOR CERTIFICATE


giving OF DEATH ot enter than one for each (b) and (c)


es not mean of dying, heart failure, etc. It means e, or compli- which caused


ns, if any, ave rise to cause (a), the under- ause last.


tions contrib- eath but not the terminal ndition given


East Boston


16 BIRTHPLACE (City) (State or country) Trecechusetts


17 NAME OF


FATHER


Washburn Westen


18 BIRTHPLACE OF FATHER (City) Duxbury


(State or country) Massachusetts


19 MAIDEN NAME


(Address) .19 197 Woodside AVE Date SEPT 10 61 OF MOTHER Hannah Hawkins


If under 24 hours Hours ............ .Minutes


13 Usual


Occupation :


housework


(Kind of work done during most of working life)


14 Industry


or Business :


own home


15 Social Security No.


none


5YRS


INTERVAL BETWEEN 11 IF STILLBORN, enter that fact here. ONSET AND 12 DEATH 2 DAYS AGE .......... Years 0 Months 21 Days


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


10a If married, widowed, or divorced


HUSBAND of


10 SINGLE


(write the word)


{(Was deceased a U. S. War Veteran,


[if so specify WAR) NO


(a) Residence. No. (Usual place of abode)


No. Bayview Nursing Home


Registered No.


Chapter 137, 1954. requires ins to print or e cause or of death on rtificates, and 48. Acts of quires Physi- print or type der signature.


Ciened B. Mars


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE.


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


RECE'VED


OF TOWN


CLERK


8


6


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.


SEP 121961 AM


X


SUFFOLK


(County)


WINTHROP (City or Town)


19 Nevada Street, Winthrop


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.


[(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number) No.


PHYSICIAN - IMPORTANT


{(Was deceased a


(First Name)


(Middle Name)


(Last Name)


(If deceased is a married, widowed or divorced woman, give also maiden name.)


19 Nevada Street, Winthrop


St.


(If nonresident, give city or town and State)


.years


.. months.


days


September 12, 1961


(Year)


9 SEX


10 COLOR


Female


White


11 SINGLE


MARRIED


WIDOWED)


or DIVORCED


Single


11a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


12 IF STILLBORN, enter that fact here.


13


AGE.


44 Yea


1.1Months ...


.2.2Days


lf under 24 hours


Hours ..........


.Minutes


14 Usual


Occupation :


State Employed


(Kind of work done during mnost of working life)


15 Industry


or Business :


Division of Emp. Security


16 Social Security No.


17 BIRTHPLACE (City) .... ErstBoston (State or country)


18 NAME OF


FATHER


Dr. Maurice S. Pobin


19 BIRTHPLACE OF


FATHER (City)


(State or country)


Russia ..


20 MAIDEN NAME


OF MOTHER


Celia Markell


21 BIRTHPLACE OF


MOTHER (City)


......


(State or country)


22 Dr. Maurice S. Rubin


Informant


(Address)


It Nevada St. 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) The bitte Glicer


(Official Designation)


(Date of Issue of Permit)


9/13/19 VIV


2 FULL NAME


IRMA


RUBIN


(a) Residence. No.


(Usual place of abode)


45


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


(Month)


(Day)


Manner of


Injury


(How did injury occur ?)


Nature of


Injury


(Signed)


MichaelA.


Boston


{Print or Type' Signature)


(Address)


7


Ohel Jacob, Woburn


Place of Burial, or Cremation.


If deceased was a U. S. War Veteran, G.L. Chap. 46, Section 10, requires physicians to insert a recital to that effect.


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


information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF


§§ 44-48.


N. D .- WKITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of


While at work?


Was autopsy performed ?


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)


Yes.


6 Was disease or injury in any way related to occupation of deceased? If s


M. D.


Luongo , M.D.


Date


9/12


61


19


DATE OF BURIAL


September 13,


1957


8 NAME OF


FUNERAL DIRECTOR


Arnold Golov


ADDRESS 1668 Bercon St. Brookline


Received and filed


SEP 13 1961


19


(Registrar)


PERSONAL AND STATISTICAL PARTICULARS


(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.) Occlusive arteriosclerosis of coronary arteries.


50M-6-60-928145


PLACE OF DEATH


M R-303 A 1


PARENTS


(City or Town)


U. S. War Veteran,


[if so specify WAR)


NO


Length of stay:


In place of death.


years ......


months.


.. days.


In place of residence.


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


FIC


11.12.


OP.F


C


RANK, RATING


W


ORGANIZATION AND OUTFIT


SERVICE NUMBER


P. MASS


SEP 131961 AN


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."


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.)"


RECEIVES"


OF


TOWA


GUERK .


PLACE OF DEATH


Suffolk (County)


INSE PE


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.


S(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)


PHYSICIAN - IMPORTANT


2 FULL NAME


Catherine Mccarthy


(First Name)


(Middle Name)


(Last Name)


[( Was deceased a


U. S. War Veteran,


[if so specify WAR)


NO


(If deceased is a married, widowed or divorced woman, give also maiden name.)


(a) Residence. No.


18 Plummer Avenue


(Usual place of abode)


Length of stay :


In place of death


2


.. years ..


2


months.


days. In place of residence 39 years.




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