USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 38
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...
(write the word)
3 DATE OF
DEATH
August
7
1961
(County)
No. MASSACHUSET.T.S.GENERAL HOSPITAL.
١٢
TO !.
١٠٠٠
٠٠٠
OCT 2 51961 AM
RM R-302
THIS IS A PERMANENT RECORD
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) resided as soon as possible. after the close of the month in which the death occurred. (See Chap. 46. Sec. 12. G. L.) at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
September 21, 1961
( Month )
(Day)
( Year)
8 SEX
Male
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
4 I HEREBY CERTIFY,
Sept. 12
61
19
to
September 21.
1961
I last saw him.
..... alive on
September 21 1961
death is said to
have occurred on the date stated above, at
INTERVAL BETWEEN ONSET AND DEATH weeks
11 IF STILLBORN. enter that fact here.
12
68
AGE.
Years.
8
Months
28
Days
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation :
President
(Kind of work done during most of working life )
14 Industry
or Business :
National Lobster Co.
15 Social Security No.
East Boston
16 BIRTHPLACE (City)
(State or country )
Mass:
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed ?
What test confirmed diagnosis ?
NO
5 Was disease or injury in any way related to occupation of deceased ?
If so, specify
Ko
PARENTS
18 BIRTHPLACE OF
Unable to obtain
FATHER (City)
(State or country )
Ireland
(Signed )
John S. Graf
M. D.
( Address )
Melrose, Mass.
Date
Sept.22, 61
19
Winthrop 6
Winthrop, Maes.
City or Town) Place of Burial or Cremation September 23, 61
DATE OF BURIAL 19
21
Informant
( Address)
73 Orchard bane, Melrose, Mass.
7 NAME OF
FUNERAL DIRECTOR
John H. Cately
ADDRESS Helrose, Mass.
A TRUE COPY
Raymond H. Greenlaw.
ATTEST :
(Registrar of City or Town where death occurred)
DATE FILED
September 25 1961
.19
X
50M-9-59-926111
PLACE OF DEATH
Middlesex ( County )
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Melrose
(City or Town making this return)
1 Melrose
(City or Town)
Melrose-Wakefield Hospital No ..
St.
[ {If death occurred in a hospital or institution,
1
give its NAME instead of street and number)
2 FULL NAME
Peter Aloysius Flannery
( If deceased is a married, widowed or divorced woman, give also maiden name.)
73 Orchard Lane
St
( Was deceased a
U. S. War Veteran.
(if so specify WAR,
Melrose Mass.
WWI
(a) Residence. No .. ( Usual place of abode )
( If nonresident. give city or town and State)
Length of stay:
In place of death .......... years .....
months.
7
days. In place of residence.
8
.years ....
.. months .......... days.
10a If married, widowed, or divorced
HUSBAND of
Esther G, O'Neil
( Give maiden name of wife in full)
(or) WIFE of.
( Husband's name in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Congestive Heart Failure
Due To
Hypertensive Cardiovascular
(b)
Heart Disease
years
17 NAME OF
FATHER
Peter Flannery
19 MAIDEN NAME
OF MOTHER
Bridget Kennedy
Unable to obtain
20 BIRTHPLACE OF
MOTHER (City)
Ireland
( State or country )
Mrs, Peter A. Flannery
Received and filed
OCT 10 1961
.19
( Registrar of City or Town where deceased resided )
102
Registered No.
That I
attended deceased from
9:05 A
.m.
TOW.
1/ 12
LERK
WINT
6
THROR. MASC.
1.0
OCT : 91961 AM
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
Oct. 5 - 1917
DATE OF DISCHARGE
Nov. 8 - 1917
RANK, RATING
Private
ORGANIZATION AND OUTFIT U. S. Army
Machine Gun Co. 301st Inf.
SERVICE NUMBER
RM R-304
1
Suffolk (County ) Winthrop (City or Town) PLACE OF DELIVERY No. Winthrop Community Hospital
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.
193
(If death occurred in a hospital or institution, give its NAME instead of street and number)
3 DATE OF
DELIVERY
Oct 4.1961
( Month )
(Day)
(Year)
4 SEX
Male
. Female .. . Undetermined
5 COLOR (if
determined)
W
6 THIS BIRTH (Check one)
SingleTwin
Triplet
7 IF MULTIPLE BIRTH, BORN :
1st .... . 2nd
. . 3rd
FATHER
8 FULL NAME Robert Cutler
14 MAIDEN NAME
MOTHER Esther Jaffe
PRESENT NAME
Esther Cutler
9
RESIDENCE, NO.
25 Alden Ave
Revere
CITY OR TOWN
STATE
15
RESIDENCE, NO.
CITY OR TOWN
25 Alden Ave Revere Mass
STREET
10 COLOR OR
RACE .... . White
11 AGE AT TIME OF THIS DELIVERY 35 (Years)
16 COLOR OR
RACE
White
17 AGE AT TIME OF
THIS DELIVERY
32
(Years)
12 PLACE OF
BIRTH
Chelsea
(City or Town
Mass
(State or country
18 PLACE OF
BIRTH
Chelsea Mass
(City or Town)
(State or country)
13 OCCUPATION Self Employed
19 INFORMANT Robert Cutler.
20 PREVIOUS DELIVERIES TO MOTHER (Do not include this fetus)
4
(a) How many children are
now living?
4
(b) How many children were born alive but are now dead? 0
(c) How many previous fetal deaths of ANY gestation age ?
21 LENGTH OF
PREGNANCY
37 .completed
weeks
22 WEIGHT OF FETUS 6 Lb. & Oz.
(or
Grams )
23 WHEN DID FETUS DIE? Before Labor
X During Labor or Delivery Unknown
24 AUTOPSY
Yes
No
25 FETAL DEATH WAS CAUSED BY: IMMEDIATE CAUSE AsphyXIA Inutero. (a)
Due To (b)
Due To (c)
OTHER SIGNIFICANT
CONDITIONS
26 Workmans Circle Place of Burial or Cremation
MELROSE
(City or Town)
DATE OF BURIAL Oct 6 196%.
27 NAME OF FUNERAL DIRECTOR TORF Funeral Service due ADDRESS 151 Washington Ave Chelsea
Received and filed OCT 6 1961 19
(Registrar
A TRUE COPY ATTEST :
I HEREBY CERTIFY that this delivery occurred on the date stated above at 4:59 Pm, and product of conception was not a live birth.
Signature of Attending Physician or Medical Examiner : Morris I. Sacks
M.D.
MORRIS
I
1
SACKS
M.D
(PRINT OR TYPE SIGNATURE)
Address
45 Shirley Ave Rever Bate Cet 6. 1961
I HEREBY CERTIFY that a satisfactory certificate of fetal death was filed with me BEFORE the burial or -transit permit was issued :
Ralph En Sirianni (Signature of Agent of Board of Health or other)
1.00
(Official Designation )
Oct. 6-1961
(Date of Issue of Permit) X
In giving AUSE OF CAL DEATH o not enter re than one use for each f (a), (b) and (c)
or maternal tion causing death (do use such as stillbirth ematurity. ) and/or ma- conditions, , which gave to above (a), stating inderlying last.
tions of fetus other which ave contrib- to fetal , but, in so s is known, not related use given ).
5M-6-60-928241
2 NAME OF FETUS (if given )
Baby Boy Cutler
St.
STREET
Mass
STATE
TO !!
ERK
FETAL DEATH 1
6
HROR MACY.
EXTRACTS OF CERTAIN SECTIONS OF CHAPTER 46 AS AMENDED OR ADDED BY CHAPTER 48. ACTS OF 1960.
OCT -61961 PM
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.
X
[ R-303
1
(County) WINTHROP
(City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE 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.
194
90 Highland Avenue, Winthrop
f(If death occurred in a hospital or institution,
St. { give its NAME instead of street and number)
No.
THOMAS
A. Mac CRINDLE SR.
PHYSICIAN - IMPORTANT
2 FULL NAME
(First Name) (Middle Name) (Last Name) (If deceased is a married, widowed or divorced woman, give also maiden name.) 228 Bowdoin Street, Winthrop
.. St.
(a) Residence. No. (U'sual 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 2.5 .. .. years months .. .. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
October
9,
1961
DEATH
(Month) (Day)
(Year)
Male
White
YES NO
12 SINGLE MARRIED WIDOWED DIVORCED UNKNOWN
C
12a If married, width E Phillips HUSBAND of
(or) WIFE of
(Husband's name in full)
13 DATE OF BIRTH Ded
28 1892
14 69
AGE ..... Years.
Months ........ .... Days
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, of in public place ?
(Specify type of place)
Manner of
(How did injury occur?)
Nature of
While at work ?
Was a
or deceased ?.
(Signe1)
M. D.
Michael A Luongo M.D
Boston
10/9 61
(Address)
Date
Winthrop
(City or Town)
61
DATE OF BURIAL 19
8 NAME OF
FUNERAL DIRECTORErnest P Caggiano
ADDRESS 197 Winthrop St, Winthrop
Received and filed OCT 11 1961 19
(Signature of Agent of Board of Health or other> Healle Officer
(Official Designation)
(Date of Issue of Permit)
10/11/61/ T V.B.
A TRUE COPY ATTEST :. (Registrar)
LEDA
18 NRTHPLACE (City) (State or country) 0
19 NAME OF FATHER Thomas Mac Crindle
20 BIRTHPLACE OF FATHER (City) (State or country) Scotland
21 MAIDEN NAME OF MOTHER Ma ry White
22 BIRTHPLACE OF MOTHER (City) (State or country) Scotland
: Thomas Mac Crindle
7 Winthrop Place of Burial, or Cremation.
50M-3-61-930213
Injury 6 Was If s 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 miton snou De carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF Injury §§ 44-48. If deceased was a U. S. War Veteran, G.L. Chap. 46, Section 10, requires physicians to insert a recital to that effect.
5 Accident, suicide, or homicide (specify)
If under 24 hours Hours .Minutes
15 Usual Occupatio
Painter
(Kindai work done during most of working life)
stry Bu. ness.
Painting Business
014-18-2940
1) Social Security No.
Fast Boston
PARENTS
250
(Print or Type V'ame)
9 SEX
10 COLOR
11 CITIZEN
OF U.S.
(Give maiden name of wife in full)
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.) C CORONARY OCCLUSION
( Was deceased a
{ U. S. War Veteran.
[if so specify WAR)
PLACE OF DEATH
SUFFOLK
Oct 13
23 Informant (Address) 228 Bowdoin St Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Halkla C. Percani.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
TO!
1
ERK :
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 lor 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.)".
PLACE OF DEATH
Suffolk (County)
LINSE PETER
STANDARD
CERTIFICATE OF DEATH
Registered No.
195
S(If death occurred in a hospital or institution, St. ? give its NAME instead of street and number) No. Winthrop Community Hospital
2 FULL NAME
James William Bolger
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
434 Revere Street St.
(If nonresident, give city or town and State)
Length of stay: In place of death .............. years. months. 3 .days. In place of residence. 3.Gears
.months.
............ days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
October
10
1961
(Year)
(Month)
(Day)
That I attended deceased from
4 L HEREBY CERTIF
October
,51
0
to.
X
Oct.
10
61
1961
death is said to
have occurred on the date stated above, at
11:55 P.m.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
Cerebral Embolus.
Due To
Rheumatic Heart Disease
(b)
Due To
Mitral Stenosis
(c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed ?
yes
What test confirmed diagnosis Ethical and Post Mortem
5 Was disease or injury in any way related to occupation of deceased? No If so, specify
(Signed)
M. D.
Charles Liberman
MIDI
(Ad
6 Woodlawn Cemetery Everett, Mass (City or Town)
Place of Burial or Cremation
DATE OF BURIAL
October 16, 1961
19
7 NAME OF
FUNERAL DIRECTOR
Cached B. March
ADDRESS
174 Winthrop St. Winthrop, Dass.
Received and filed OCT 11-1961 . 19 ..
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
9 COLOR
8 SEX
male
white
10 SINGLE
(write the word)
MARRIED marriec
WIDOWED
or DIVORCED
10a If married, widewed, or divorced
gdrotHerraldenhauer
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
AGE
64Years.
O
Months ..
11.Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation :
power plant engineer
(Kind of work done during most of working life)
14 Industry
or Business :
Metropolitan District Com.
15 Social Security No.
none
St. John's
16 BIRTHPLACE (City)
(State or country)
New foundland,
17 NAME OF
FATHER
Edward Bolger
18 BIRTHPLACE OF
FATHER (City)
St. Johns
(State or country)
New Foundland.
19 MAIDEN NAME
OF MOTHER
Ellen Rutledge
20 BIRTHPLACE OF
St. Johns
MOTHER (City)
(State or country)
New Foundland
21 Informant
Irs James W. Bolger
(Address) 434 Revere St. Winthrop,
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or/ transit permit was issued: Halkre Circanning
V (Signature of Agent of Board of Health or other)
Thealte Ovice 10/11/01/ (Official Designation) (Date of Issue of Permit)
1 V.B.
1 R-301A 1
RUCTIONS FOR CERTIFICATE
giving OF DEATH not enter than one : for each (b) and (c)
oes 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 s to print or cause or f death on ificates, and 48, Acts of uires Physi- print or type Fer signature.
1-1-59-926662
Winthrop (City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
To be filed for burial permit with Board of Health or its Agent.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
[if so specify WAR)
NO.
I last saw himalive on
COM.
10
19
INTERVAL
BETWEEN
ONSET AND
DEATH
3 days
10yrs
10 yrs
PARENTS
(PRINT OR TYPE SIGNATURE) Winthrop, Mass Date 10/11/1961
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE.
RANK, RATING
F
ORGANIZATION AND OUTFIT
SERVICE NUMBER
2 70 RA
RVBEŞIR PIRE PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice : (1) Attending physiciane wilt ceftify to such deaths only as those of persons Opring) 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
R-301A
1
PLACE OF DEATH
Suffolk (County)
CANSE PETIT
TYCH
STANDARD
CERTIFICATE OF DEATH
Registered No.
196
No.
Winthrop Convalescent Home 142 Pleasant St. Bertha .M ...... Dennison (Kempton ) (First Name) ( Middle Name) (If deceased is a married, widowed or divorced woman, give also maiden name.) (Last Name)
[(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,
(if so specify WAR)
10
164 Vane Street
Revere
(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
DEATH
Oct.
10.
1961.
(Month) (Day)
(Year)
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIEDY]
WIDOWED, Idowed
or DIVORCED
4 I HEREBY CERTIFY
Aug. 30
19.61
Oct 10,
That I attended deceased from
19. 61
I last saw
Leralive on
Coc+10
19 61, death is said to
have occurred on the date stated above, at
1:30 P. m.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE (a) CORONARY Thrombosis
Due To
(b)
Rheumatic Heart DZ
Due To
Gener Alized Arteriosclerosis
(c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed? What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed) Minis & Sacks
MORRIS I SACKS
MID
(Address)
(PRINT QR TYPE SIGNATUREY 45 Shirley Ave Rev Date Octio
, 19 601
Locuet Grove 6
Rockport
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL Oct. 13,1861
19
7 NAME OF
FUNERAL
DIRECTOR
Leslie W. Pike
ADDRESS
305 Beach St. Revere
Received and filed
OCT 1 3 1961
19
(Registrar)
PARENTS
20 BIRTHPLACE OF MOTHER (City) (State or country) Nova Scotia
21 Herbert Dennison
Informant (Address) 164 Vane St. Revere
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial/or transit permit was issued: Trable 6. 9 manuel Signature of Agent of Board of Health or other) Offices 10/13/61
(Official Designation)
(Date of Issue of Permit)
JCTIONS OR CERTIFICATE
iving OF DEATH t enter han one for each b) and (c)
s not mean of dying, eart failure, c. It means or compli- rich caused
s, if any, ve rise to use (a), he under- use last.
ons contrib- ath but not the terminal dition given
Chapter 137, 954. requires s to print or cause or f death on ificates, and 48, Acts of uires Physi- rint or type er signature.
-
-
(Kind of work done during most of working life)
one
15 Social Security No. None
Bear ..... River.
BIRTHPLACE (City (State or country) ova Scotia
17 NAME OF
FATHER
Isaac Vempton
18 BIRTHPLACE OF
FATHER (City)
Unable to Learn
M. D (State or country) Nova Scotia
19 MAIDEN NAME OF MOTHER Vary Parker
If under 24 hours
86 11
Months
2
Days
Hours.
Minutes
13 Usual
Occupation :
At Home
14 Industry
or Business :
20 yrs. 30 yrs,
10a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Frank E. Dennison
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
INTERVAL BETWEEN ONSET AND DEATH 1 hour 12 AGE Years.
St.
(Usual place of abode)
1
65
To be filed for burial permit with Board of Health or its Agent.
Winthrop (City or Town)
TEVERE 19-4-11
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
2 FULL NAME
(a) Residence. No.
PERSONAL AND STATISTICAL PARTICULARS
28145
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
CLERK
"SS
M
TC
( Mi )
11
6
':10
OCT 1 31961 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.
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