USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1962 > Part 14
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years
months.
.days. In place of residence.
... years.
.. months
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
Mar
13
1962
(Month)
(Day)
(Year)
4 1 HEREBY CERTIFY
That I attended deceased from
Aug 5
60
Mar
13
19
to ...
19
19 .. 62
death is said to
have occurred on the date stated above, at
m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Arterio sclerosis of
(a)
INTERVAL BETWEEN ONSET AND DEATH
cerebral arteries
10 yrs
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widowed
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Arthur Stabb
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
84
1
17
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business :
At Home
15 Social Security No.
None
16 BIRTHPLACE (City)
(State or country)
Mass
17 NAME OF FATHER David C Nickerson
18 BIRTHPLACE OF
Leominster
FATHER (City)
(State or country)
Mass
19 MAIDEN NAME
OF MOTHER
Helena Chase
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
21
Mrs. Nathan A. Tufts Sr
Informant ...
Monte M. Basbas
ATTEST:
(Registrar of City or Town where death occurred) March 14, 1962
DATE FILED
19
(Registrar of City or Town where deceased resided)
PARENTS
Joseph R Cotter (Signed) ...... 1155-Boylston St
M. D.
(Address)
Newton
Mass
Date.
19
6 Evergreen Cem
Leominster Mass
Place of Burial or Cremation
(City or Town)
March
15,
62
DATE OF BURIAL
Rober T. Perkins
7 NAME OF FUNERAL DIRECTOR 30 Prospect St Waltham
ADDRESS
Received and filed.
MAY 4 - 1962
19
4 days
CONDITIONS
Was autopsy performed ?...
No
What test confirmed diagnosis?
Clin .... Observation No
5 Was disease or injury in any way related to occupation of deceased? If so, specify
OTHER
SIGNIFICANT
Pneumonia left lung
PLACE OF DEATH
No ..
Buswell Park Nursing Home 7 Buswell Park, Newton Orland
2 FULL NAME.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
Winthrop
Mass
(Usual place of abode)
10
62
I last saw h.
erlive on
Mar
12
11:45 A
AGE
Years
Months.
Days
Housewife
Leominster
Mass
19 --- (Address) 514 Pitman Ave Pitman N J
A TRUE COPY
Leominster
13 Mar
62
Y
TON
HAY - 41962 AM
PLACE OF DEATH
Suffolk
/&County) Boston (City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
OUT - OF - TOWN
To be filed for burial permit with Board of Health or its Agent. 02697
70
2 FULL NAME dvs Verna (First Name) (Middle Name)
(Coffin)
Douglas
[(Was deceased a
U. S. War Veteran.
(Last Name)
[if so specify WAR)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 3 Buckthorn
Terrace
St
Winthrop
mass
(Usual place of abode)
Length of stay: In place of death.
.years.
months ..
11 days.
In place of residence
.years
2 months.
7.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
March
14
1962
(Year)
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
(Month)
(Day)
4 I HEREBY CERTIFY,
That I attended deceased from
march
4
1962, to March
14
19.6 .. 2 ...
I last saw h&.w ... alive on
March
14
1962, death is said to
have occurred on the date stated above, at
6:35
Pm.
DETWEEN
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a) Uremia due to uretral overal
ONSET AND Y
Due To
(b)
metastasthe Disease
Due To
(c)
Ca of color -
7yrs
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
...
Yes
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased? If so, specify
No
(Signed)
ELMER C. BARTELS
M. D
Elma C. Barts
605
(Address) mmenura ale .....
3-14 1062
6 Winthrop Place of Burial or Cremation (City or Town)
Winthrop
DATE OF BURIAL
March
17
1662
7 NAME OF
FUNERAL DIRECTOR
Howard S Reynolds
Winthrop
Mass
ADDRESS
Received paid filed
Charles & MAC
(Registrar)
PARENTS
17 NAME OF
FATHER
George Coffin
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Prince Edward Island
19 MAIDEN NAME
OF MOTHER
Minnie Boyd
20 BIRTHPLACE OF
Moncton
MOTHER (City)
(State or country)
"New Brunswick
21 L Eugene Douglas
Informant
(Address)
3 Buckthorn Terr, Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: canto
(Signature of Agent of Board of Health or other) 6314 3-15-62
(Official Designation)
(Date of Issue of Permit)
CTIONS OR CERTIFICATE
iving F DEATH It enter than one for each >) and (c)
i's not mean of dying, heart failure, ic. It means , or compli- which caused
iss, if any, "the rise to ause (a), the under. ause last.
Tions contrib- cath but not the terminal cidition given
53.8
Chapter 137, 1954. requires uns to print or ne cause or of death on ertificates, and 48, Acts of quires Physi- print or type der signature. .C.
Y 8-1962
R-301A 1
new England Baptist Hospital No.
CERTIFICATE OF DEATH
Registered No.
[(If death occurred in a hospital or institution,
St. ? give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
MARRIED
WIDOWED
or DIVORCED
Married
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
INTERVAL
(or) WIFE of
L Eugene Douglas
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
Years ....
7
Months ..
Days
If under 24 hours
.. Hours .............. Minutes
13 Usual
Occupation :
Housewife
(Kind of work done during most of working life)
14 Industry
or Business :
Own home
15 Social Security No. .
Tone
16 BIRTHPLACE (City).
(State or country) Hass
Winthrop
(FRINT OR TYPE SIG ALURE)
ot Mos
58
2
(If nonresident, give city or town and State)
58
MAR 16 1962 19
A TRUE COPY ATTEST:
Charles it: Mackie City Registrar
1
MAY - 81962 AM
R-303
of Death. See reverse side for additional information. See also Chap. 38, 5§ 6, 20; Chap. 46, §§ ), 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.
SOM - 3-61-930213
M.C.
PLACE OF DEAT
SUFFOLK
(County)
BOSTON
(City or Town)
Che Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
OUT - OF - TOWN To be filed for burial permit with Board of Health or its Agent.
71 '
1
En route to Massachusetts General Hospital(If death occurred in a hospital or institution. No. St. ...... "T give its NAME instead of street and number)
2 FULL NAME
MARY E FARRELL
(First Name)
(Middle Name)
( EASTMAN
(Last Name)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
37 Pebble Avenue
St.
Winthrop, Massachusetts
(L'sual place of abode)
Length of stay: In place of death.
years.
months.
days. In place of residence.
45 years
months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
March
16.
1962
(Month)
(Day)
(Year)
4T 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.) Acute pulmonary edema Arteriosclerotic heart disease
9 SEX
10 COLOR
11 CITIZEN
OF U.S.
YES
NO
12 SINGLE MARRIED WIDOWED DIVORCED UNKNOWN
12a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
BERNARD
(Give maiden name of wife in full)
F. FARRELL
(Husband's name in full)
13 DATE OF BIRTH SAPT 6, 1885
14
AGE 16 Years.
Morish s ......... .. Dayo
HOME MAKER
(Kind
work done during most of working life)
16 Industry
of Business
HOME
1> Social Security No.
NONE
18 BIRTHPLACE (City)
(State or country)
MASS
19 NAME OF
FATHER
GEORGE T, EASTMAN
20 BIRTHPLACE OF
FATHER (City)
(State or country)
ENGLAND
21 MAIDEN NAME
OF MOTHER
ELLEN SULLIVAN.
22 BIRTHPLACE OF
MOTHER (City)
(State or country)
IRELAND
(Print or Type Namne) 3/17 62
(Address) Boston
7 WINTHROP
Place of Burial, or Cremation.
WINTHROP
(City or Town)
. DATE OF BURIAL MARCH. 19 16.2
8 NAME OF
FUNERAL DIRECTOR
MAURICE W KIRBY
ADDRESS
WINTHROP
MAR 20 1962 .19
Received ghd filed
Charles
2) mackie
(Official Designation)
(Date of Issue of Permit)
.......
P
A FRUE COPY ATTEST :. (Registrar)
PARENTS
6 Was dispastor injury in any way rel teu ip cccu, Trin of deceased?
(Signed).
Michael A. Luong
M. D.
Date
.......
MRS EVERLYN PORTER
23
Informant
(Address)
1179 SHIPLEY ST WINTHROP
...
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: & Nonato
Y8 1962
X 1
If deceased was a U. S. War Veteran, G.L. Chap. 46, Section 10, requires physicians to insert a recital to that effect.
Manner of
Injury
(How did injury occur?)
Nature of Injury ...
No .........
While at work ? Was autopsy performed ........
15 Usual
Occupatica:
If under 24 hours .Hours .. Minutes
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)
FEMALE
WHITE
PHYSICIAN - IMPORTANT
[ (Was deceased a
U. S. War Veteran, (if so specify WAR) NO
( If nonresident, give city or town and State)
Registered No.
02832
(Signature of Agent of Board of Health or other) 6340 3-14-62
BOSTON
A TRUE COPY ATTEST Charles it. Mackie City Registrar
MAY -81962 AM
X PLACE OF DEATH
Suffolk (County)
Boston
(City or Town)
Massachusetts General Hospital
St Ì give its NAME instead of street and number) No.
2 FULL NAME ..
Bernard Delaney
( lf deceased is a married, widowed or divorced woman, give also maiden name.)
(4) Residence No. 26 Sturges Street SI Winthrop, Massachusetts (If nonresident. give city or town and State)
( I'sual place of abode )
10
Length of stay: In place of death .............. years .............. months ............. days. In place of residence
years.
.months
.... (lays.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
March
.20
1962
(Month)
(Day) 110
(Year)
8 SEX
male
4 COLOR
white
10 SINGLE
(wute the word)
MARRIED divorced
WIDOWED
or DIVORCED
4 I HEREBY
CERTIFY,
Thatas attended deceased from
March 20
19
62
to
March 20
136.2
last saw himalive on
March .... 20.
19.62., death is said to
have occurred on the date stated above, at ...
3:20 .... 2m.
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
SAGE
:62
.Months ...........
.Days
If under 24 hours
Hours .............. Minutes
Due ToArteriosclerosis body
(b)
Generally
Due To (c)
OTHER
Status Asthmaticus
unk y
BIRTHPLACE (City)
(State or country)
vermont
17 NAME OF
FATHER
John Delaney
18 BIRTHPLACE OF
Lydonville
FATHER (City)
(State or country)
Vermont
19 MAIDEN NAME
OF MOTHER
Helen
?
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
?
21
Informant
(Address) 72 Chestnut St., N. Reading
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: R2 Kagerder
(Signature of Agent of Board of Health or other)
6413
3-22-6.
(Official Designation)
(Date of Issue of Permit)
TVBV
----
To be filed for buried permit with Board of Health or its Agent.
Registered No
02952 ....
TUCTIONS
MIERTIFICATE
Living IF DEATH t enter chan one Hfor each ) and (c)
's mat mean af dying, eart failure, tc. It means , or campli- hick caused 20
ss, if any, tve rise ta ause (a), the under. Buse last.
ians contrib- cath but nat the terminal Idition given
Chapter 137. 54. requires is to print or cause or death on ificates, and 48. Acts of aires Physi. rint or type er signature.
/ 8- 1962
59-925686
....
Received Charles & Mack 19
PARENTS
(Signed)
Charles L. Clay, M. D.
M. D.
(PRINT OR TYPE SIGNATURE) (AASS't. Dir. Mass. Gen
Hosp. March 20,62
6
Winthrop Cemetery
Winthrop
(City or Town)
Place of Burial or Cremation
DATE OF BURIAL
March 23.
62
19.
7 NAME OF
FUNERAL DIRECTOR
147
Ernest P. Caggiano
ADDRESS
Winthrop Su.,
winthrop
3-4962
10a If married, w
HUSBAND of
Rogerschultz
(Give maiden name of wife in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Coronary Heart Disease
DETWEEN
ONSET AND
DEATH
15 yr
13 Usual
Occupation :
cook
(Kind of work done during most of working life)
Industry
or Business:
restaurant
15 Social Security No.
....
031-07-8067
Lydonville
SIGNIFICANT
CONDITIONS
Was autopsy performed ? ....... y.es
What test confirmed diagnosis ?
autopsy
5 Was disease or injury in any way related to occupation of deceased? If so, specify
unk y
(a)
R-301A 1
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
OUT - OF - TOWN 72
Hugh Murphy
jilf death occurred in a hospital or institution,
PHYSICIAN - IMPORTANT [(Was deceased a {U. S. War Veteran, (if so specify WAR)
A TRUE COPY ATTEST:
Charles it. Mackie City Registrar
1 )
1201
MAY - 81962 AM
OM R-301A 1
ditions, if any, h gave rise to cause (a), the under- cause last.
nditions contrib- o death but not to the terminal condition given
- Chapter 137, 1954, requires ians to print or he cause or of death on ertificates, and r 48, Acts of equires Physi- o print or type nder signature.
1-11-59-926662
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.
73
[(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number) PHYSICIAN - IMPORTANT
2 FULL NAME
Frederic". Mulloney
(If deceased is a married, widowed or divorced woman, give also maiden naine.)
(a) Residence. No.
5.Loring Road, Winthrop
(Usual place of abode)
Length of stay: In place of death. ............. years ........... months. 2 days. In place of residence.
54
.years ...
......... months .............. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
April
9,
1962
(Year)
(Month)
(Day)
4 I HEREBY CERTIFY,
That I attended deceased from
Nov .... , 195.5 ..... , to .... April ..... 9,
I last saw him alive on .... April .... 9,
19.62 ... , death is said to
have occurred on the date stated above, at
7:00 .A .... ın.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
Acute Myocardial Infarction ....
INTERVAL
BETWEEN
ONSET AND
DEATH
3 days
11 IF STILLBORN, enter that fact here.
If under 24 hours
Hours. Minutes
13 Usual
STATICIAN
Occupation :
(Kind of work done during most of working life)
14 Industry
INVESTMENT
15 Social Security No.
011-05-1993
BIOSTON
16 BIRTHPLACE (City)
(State or country)
MASS
17 NAME OF
FATHER
THOMAS A MULLONEY
18 BIRTHPLACE OF
BOSTON
FATHER (City)
(State or country)
MASS
19 MAIDEN NAME
OF MOTHER
MARGARET A CHAEFER
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
MASS
GRACE MI HAS KELL
5-LORING RD WINTHER
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
7 NAME OF FUNERAL DIRECTOR MAURICE W KIRBY ADDRESS 210 WINTHROP ST WINTHROP Talle C. fireaungs.
Received and filed APR-10-1982
19
(Registrar)
8 SEX
MALE
9 COLOR
WHITE
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
SINGLE
10a If married, widowed, or divorced HUSBAND of (Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
Due To
Arteriosclerotic Heart Diseas
(b)
7 yrs
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
None
Was autopsy performed ?
No
What test confirmed diagnosis ?
Clinical and Laboratory
NOZ
5 Was disease or injury in any way related to occupation of deceased ? If so, specifx
PARENTS
(Signed) M. Traurig. M. D.
M. Traunstein, Jr. , M.DL
(Address)
(PRINT OR TYPE SIGNATURE) 73 Bartlett ... Road.,. Date ..
April 919 62
Winthrop
6 MINTHA60
Place of Burial or Cremation
APRIL 12
19.42
(City or Town)
DATE OF BURIAL
WINTHROP 21 Informant (Address)
BOSTON
(Signature of Agent of Board of Health or other)
Healthy Aprice 4/10/62
(Date of Issue of Permit)
(Official Designation)
.1.
[(Was deceased a U. S. War Veteran, lif so specify WAR)
NO
St.
(If nonresident, give city or town and State)
WINTHROP COM HOSP No.
To be filed for burial permit with Board of Health or its Agent.
A
STRUCTIONS FOR DAL CERTIFICATE
In giving UE OF DEATH not enter re than one se for each ), (b) and (c)
does not mean ode of dying, s heart failure, 1, etc. It means case, or compli- which caused
12
5 9 years.
..... Months.
Days
Statisti
or Business :
62.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RULES OF PRACTICE
6
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. APR 101962
(2) Board of Health physicians will certify to such 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.
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.
74
St. ¿ give its NAME instead of street and number) En route to Winthrop Community Hospitadeath occurred in a hospital or institution. No.
2 FULL NAME
ELLEN
DAVIDSON
PHYSICIAN - IMPORTANT
[(Was deceased a
(First Name)
(Middle Name)
(Last Name)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
44 Sprague Street
Malden, Mass.
(a) Residence. No. (Usual place of abode)
.St.
( If nonresident, give city or town and State)
7
Length of stay: In place of death ...
.. years.
months.
days.
In place of residence ..
years.
months.
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
April
11, 1962
(Day)
(Year)
9 SEX 10 COLOR Female White
II CITIZEN
OF U.S.
YES NO
12 SINGLE MARRIED WIDOWED DIVORCED UNKNOWN
12a If married, widowed, or divorced HUSBAND of
(or) WIFE of
Joseph
(Give maiden name of wife in full) DAVIDSON
(Husband's name in full)
13 DATE OF BIRTH Sept 14, 1903
14 58
5
Months .........
.. Days
House wares
(Kind of work done during most of working life)
16 Industry Business:
OWN Home
I> Social Security No.
a. N. B.L.
18 NRTHPLACE (City) (State or country) MASS
19 NAME OF
FATHER
Michael O'MEARA
20 BIRTHPLACE OF FATHER (City) (State or country)
FRElAnd
21 MAIDEN NAME
OF MOTHER
MARY HANLON
22 BIRTHPLACE OF MOTHER (City) (State or country)
Ireland
23 Informant Joseph J. Davidson.
(Address) 44 SPRAGue St. Malden
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) Heatthe Great
(Official Designation)
16
4/13/62
(Date of Issue of Permit) /
A TRUE COPY ATTEST :. (Registrar)
If deceased was a U. S. War Veteran, G.L. Chap. 46, Section 10, requires physicians to insert a recital to that effect.
DEATH in plain terms, so that it may be properly classified under the International Classification of Causes
of Death. See reverse side for additional information. See also Chap. 38, §§ 6, 20; Chap. 46, §§ 9, 10; Chap. 114,
§§ 44-48.
50M -3-61-930213
7
Holy Cross Place of Burial, or Cremation. (City or Town) April 14 1962 DATE OF BURIAL
8 NAME OF FUNERAL RtRedeRick J. MAGRATH
ADDRESS EAST Boston
Received and filed
APR 13 1962
19
PARENTS
1 M. D.
Michael (Print or Type ame)
Longo, M.D.
Boston
Date
4/11
62
19
(Address)
6 Was hseasefor injury in any way rel ted to comp ation of deceased ?
......
(Signed)
(Specify type of place)
Manner of
Injury
(How did injury occur ?)
Nature of Injury
While at work ?
Was amtopsy performed
If under 24 hours Hours Minutes
Years.
15 Usual Occupation :
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 ?
Hypertensive cardio-vascular
disease.
5 Accident, suicide, or homicide (specify) Date and hour of injury 19
(Month)
Maldi
5- 46'2
PLACE OF DEATH
SUFFOLK
information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF
-
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.) Coronary occlusion.
U. S. War Veteran,
lif so specify WAR)
No
Malden
EAST BOSTON
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 Alfons 3.96hoff 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.)" .
IX
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
75
Somerville
(City or Town making this return)
COPY OF CERTIFICATE OF DEATH
Registered No. 231
{(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
William J. Murphy
(If deceased is a married, widowed or divorced woman, give also maiden name.)
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