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