USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1962 > Part 45
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public place ?
Home
(Specify type of place)
Manner Strangulation by ligature
Injury
Nature of
( cotton" pe''"ma""bottom}
Injury
While at work ? Was autosy performed ? ......... .........
6 Was disease or injury in any way related to occupation & deceased ?
If shop specify ...
(Signed Michael
Luongo, M.D.
Boston
(Address)
Date
WINTHROP
(City or Town)
DATE OF BURIAL
DEC. 12, 1962
8 NAME OF DIPIETROLAVAZZA ADDRESS 11HENRY ST EAST BOSTON
Received and filed
19
9 SEX
FEMALE
10 COLOR
WHITE
11 SINGLE
MARRIED
( write the word )
SINGLE
DIVORCED UNKNOWN
12 If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
13 DATE OF BIRTH
14 AGE 7
If under 24 hours .Hours Minutes
15 Usual
Occupation
STUDENT
(Kind &work done during most of working life)
HIGH SCHOOL
16 Industry or Business.
17 Social Security No. ....... 017-34-5430
18 BIRTHPLACE (City)
(State or country)
WINTHROP, MASS.
19 NAME OF
FATHER
JOHN L. CADIGAN
20 BIRTHPLACE OF
FATHER (City)
BOSTON
(State or country)
MASS
21 MAIDEN NAME
OF MOTHER
HILDA M. DI PIETRO
22 BIRTHPLACE OF
MOTHER (City)
BOSTON
(State or country)
MASS
23 JOHN L. CADIGAN
Informant
(Address) 9BANKS ST, WINTHROP MASS.
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) Health Offeuer
12/11/65
(Official Designation)
(Date of Issue of Permit)
İ
1
§§ 44-48.
50M-9-61-931348
of Death. See reverse side for additional information. See also Chap. 38, §§ 6, 20; Chap. 46, §§ 9, 10; Chap. 114,
If deceased was a U. S. War Veteran, G.L. Chap. 46, Section 10, requires physicians to insert a recital to that effect.
-
: burial permit Ud of Health Agent.
information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF
DEATH in plain terms, so that it may be properly classified under the International Classification of Causes
PLACE OF DEATH
No.
MARGARET ANN CADIGAN
f (Was deceased a U. S. War Veteran, [if so specify WAR)
MASS
St.
(If nonresident, give city or town and State)
PARENTS
M. D.
(Print or Tape Name)
12/8 62 19.
, WINTHROP Place of Burial, or Cremation.
How
Yes
.......
₹ R-303
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
11/12 1
RULES OFPRACTICEA
5 ERK
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 injuryROP."
(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. DEC 111962 PM
(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.)"
FRM R-301
dur burial permit Be'd of Health Agent. TICTIONS OR CERTIFICATE
TOR TYPE IR CAUSES EATH t enter than one for each b) and (c)
Bes not mean of dying, seart failure, tc. It means e:, or compli- hich caused
ins, if any, ave rise to cause (a), the under- cause last.
stions contrib- oleath but not the terminal ndition given
PLACE OF DEATH
Suffolk
(County)
Winthrop
(City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or Town making this return)
227
§(If death occurred in a hospital or institution, St. ( give its NAME instead of street and number)
2 FULL NAME
Mary Carpenter (Barden)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ..
226 Cottage Park Rd.
(Usual place of abode)
........ Winthrop
Length of stay: In place of death .......... years.
6
.months .......... days. In place of residence .......... years ...
(If nonresident, give city or town and State)
6 months .......... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
December 9, 1962
DEATH
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY That I attended deceased from
19 ....
Dec.
9
1962
to ...
I last saw hejalive on
Dec.
9
19.6 2 death is said to
have occurred on the date stated above, at
1:397 m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
myecuriel
Heart
Due To
DISTuJe
(b) Carteriestjerosis -
Due To (c)
Carcinoma -
OTHER
SIGNIFICANT
CONDITIONS
abdominal ware
Was autopsy performed?
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased? /2 If so, specify
(Signa
M. D.
Joseph GREGORIE
(Print or Type Name)
(Address)
19
194 WashurtIch Date 12-11
62
Ellenville
Fantine Till Cemetery, New York
6
Place of Turial or Cremation
(City or Town)
DATE OF BURIAL
December 13,
19.62
7 NAME OF
FUNERAL DIRECTOR
Ernest P. Caggiano
ADDRESS
147 Winthrop Street , Winthrop
Received and filed
.... 19.
(Registrar)|
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
female
9 COLOR
white
10 SINGLE
MARRIED
WIDOWED
DIVORCED Widowed
UNKNOWN
11 If married, widowed, or divorced HUSBAND of
(or) WIFE of
(Give maiden name of wife in full)
Daniel Carpenter
(Husband's name in full)
12
86
5
Months
Days
24
If under 24 hours
Hours ....... Minutes
13 Usual
Occupation :
(Kind of work done during most working life)
14 Industry
or Business :
at home
15 Social Security No.
16 BIRTHPLACE (City) New York
(State or country )
New York
17 NAME OF
FATHER
Everett Barden
18 BIRTHPLACE OF
FATHER (City)
(State or country)
New York
19 MAIDEN NAME
OF MOTHER
Alice Holmes
20 BIRTHPLACE OF
MOTHER (City)
(State or country) New York
21 Informant
Mrs. Alice Cole
(Address)
226 Cottage Park Rd., Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Trackte E- perearcours 4 (Signature of Agent of Board of Health or other)
12/12/62
(Official Designation)
(Date of Issue of Permit) V
-
PARENTS
2-932382
X I
No 226 Cottage Park Rd.
Registered No.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
no
(write the word)
INTERVAL BETWEEN ONSET ANO DEATH
AGE
Years.
Housewife
.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
C ..
THROP
RULES OF PRACTICE DEC 121962 AM
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice : (1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease un- related to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occu- pation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very impor- tant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa. tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Chil- dren not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook- hotel, etc. For a person who had no occupation whatever write none.
25M-3-61-930213 Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at as soon as possible after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) the time of death should be transmitted on Form R-305 to the clerk of the city or town in which the deceased resided Injury
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
December 10.
1962.
(Month)
(Day)
(Year)
9 SEX
Male
10 COLOR
White
11 CITIZEN
OF U.S.
YES
NO
12 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
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.) Fractured neck; fractured ribs - right & punctured lung: compound fracture - right ankle
12a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
13 DATE OF BIRTH
Feb. 23, 1940.
5 Accident, suicide, or homicide (specify)
Accident
Date and hour of injury
1:45 AM-12/10/ 19 62
If accidental, was injury causally related to the death ?
Yes
Where did
Ludlow, Mass.
(City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in
public place ?
Turnpike
(Specify type of place)
Manner of
Car skidded & hit guard rail
Injury
(How did injury occur ?)
Nature of
Thrown out of car & killed
While at work? ... NO.
.Was autopsy performed ? NO.
6 Was disease or injury in any way related to occupation of deceased ?..... O If so, specify
(Signed)
Benjamin Schneider
M. D.
(Address)
Monson, Mass
Date 12/10 1962
7
Winthrop Cem.
Winthrop Lass
Place of Burial or Cremation.
(City or Town)
DATE OF BURIAL
December13
.19.62
8 NAME OF
FUNERAL DIRECTOR
Myron W. Ryder, Jr.
ADDRESS
50
Hadley Falls, Mass.
Received and filed
GEC 19 1962
19
(Registrar of City or Town where deceased resided)
PARENTS
19 NAME OF
FATHER
Edwin H. Blomquist
20 BIRTHPLACE OF
FATHER (City)
Somerville.
(State or country)
Mass.
21 MAIDEN NAME
OF MOTHER
Thelma Stonwood
22 BIRTHPLACE OF
Boston
MOTHER (City)
(State or country)
Mass.
23 Personnel Records
Informant
(Address)
Westover A . F. B.
Mass.
A TRUE COPY.
ATTEST :
John Brown
(Registrar of City or Town where death occurred)
DATE FILED
December 14.
19 62
.
X PLACE OF DEATH
Hampden (County)
Palmer
(City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
PALMER
(City or town making return)
Registered No.
228
No.
Wing Memorial Hosp.
[(If death occurred in a hospital or institution,
St. Į give its NAME instead of street and number)
2 FULL NAME
Peter Blomquist
{(Was deceased a
U. S. War Veteran,
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(if so specify WAR)
-
St.
Winthrop, Mass.
(a) Residence. No.
(Usual place of abode)
Pleasant
(If nonresident, give city or town and State)
Length of stay: In place of death .............. years .............. months.
1
days. In place of residence.
2.2years ....
... months .............. days.
14
AGE ... 2.MYears.
9
Months ....
17
.Days
If under 24 hours
Hours .......
Minutes
15 Usual
Occupation :
Airman - U. S. Air Force
(Kind of work done during most of working life)
Injury occur ?
16 Industry
or Business :
U. S. A. F.
17 Social Security No.
020-32-2683
18 BIRTHPLACE (City)
(State or country)
Mass.
Winthrop
₹-305 1
DEC 1 91962 AM
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
December 10, 1962.
RANK, RATING
A 2/C
ORGANIZATION AND OUTFIT
Transportation Sod.
SERVICE NUMBER
AF 11374678
R: R-303 Ir burial permit ad of Health Agent.
information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF
If deceased was a U. S. War Veteran, G.L. Chap. 46, Section 10, requires physicians to insert a recital to that effect.
X 1
SUFFOLK
(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
(City or Town making this return )
Registered No.
229
85 Sagamore Avenue, Winthrop f(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number) No.
PHYSICIAN - IMPORTANT
2 FULL NAME WILLIAM SAGAN (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.
85 Sagamore Avenue, Winthrop
.St.
(If nonresident, give city or town and State) ( Usual place of abode)
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
December
14.
1962
(Month) (Day)
(Year)
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.) Acute interstitial pneumonitis.
Pulmonary edema.
(Husband's name in full)
13 DATE OF BIRTH
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 public place ?
Manner of
Injury
(How did injury occur?)
Nature of Injury
While at work? Was autopsy performed ?
Yes
6 Was disease or injury in any way related to occupation & deceased ?
If so, Cepocity
(Signed Michael A. Luongo,A.D
M. D.
(Print or Type Name)
Boston
12/14 19 62
LIFERETH ISRAEL- Place of Burial, or Cremation.
EVERETT (City or Town)
DEC. 14 1962 DATE OF BURIAL
8 NAME OF FUNERAL DIRECTOR Benjamin Birnbach
ADDRESS 10 Washington Sty Dorchester
Received and filed DEC 14
19
9 SEX
MALE
10 COLOR
WHITE
11 SINGLE MARRIED WIDOWED DIVORCED UNKNOWN
( write the word ) SINGLE
12 If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
14 AGE 0 Years ........ Months ........... .Days
If under 24 hours Hours Minutes
15 Usual
Occupation
(Kind of work done during most of working life)
16 Industry or Business ....
17 Social Security No. NONE
8 BA
18 BIRTHPLACE (City}
(State or country)
BOSTON, MASS.
19 NAME OF
FATHER
CHARLES SAGAN
20 BIRTHPLACE OF
FATHER (City)
(State or country)
BOSTON, MASS
21 MAIDEN NAME OF MOTHER PNYLISS GAMERMAN
22 BIRTHPLACE OF MOTHER (City) (State or country)
CHARLES SAGAN
23 Informant (Address) 85 SAGAMORE AVEI WINTHROP
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Palak 6. Sirianni
(Signature of Agent of Board of Health or other)
Stealth Officer Der. 14. 1962
(Official Designation)
(Date of Issue of Permit)
1
§§ 44-48.
50M-9-61-931348
(Address)
Date
PARENTS
BOSTON, MASS.
DEATH in plain terms, so that it may be properly classified under the International Classification of Causes
PLACE OF DEATH
of Death. See reverse side for additional information. See also Chap. 38, §§ 6, 20; Chap. 46, §§ 9, 10; Chap. 114,
(Specify type of place)
SPACE FOR ADDITIONAL INFORMATION
.....
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
: RANK, RATING
ORGANIZATION AND OUTFIT
THROP
SERVICE NUMBER
DEC 1-41062-14
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.)"
7
R-301A 1 Winthrop
Suffolk (County ) (City or Town) PLACE OF DEATH No. Bay View Nursing Home
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.
Registered No.
230
§(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)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
390 Winthrop Street
(a) Residence. No. (L'sual place of abode)
Length of stay: In place of death
.. years.
3
months
.days. In place of residence.
32
years
months
.. days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED Widow
10a If married, widowed, or divorced
HUSBAND of
(or) WIFE
""illiam A L.cDougail
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
87
Years
1
Months.
26 Days
If under 24 hours
Hours ...........
.. Minutes
13 Usual
Occupation :
Housewife
(Kind of work done during most of working life)
14 Industry
or Business :
Cun Home
15 Social Security No.
1. one
Boston
16 BIRTHPLACE (City)
(State or country)
tass
17 NAME OF
FATHER
Christopher Kammerer
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Germany
19 MAIDEN NAME
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Unable to obtain
21 Donald McDougall
Informant
(Address)
390 . inthrop St. winthrop, lass
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Talk& C. fireanne x
(Signature of Agent of Board of Health or other) Health Office 12/18/62
(Date of Issue of Permit)
(Official Designation) /
(Registrar)
PARENTS
6
woodlawn
Everett
Place of Burial or Cremation
DATE OF BURIAL
(City or Town)
Dec. 19
62
19.
7 NAME OF
FUNERAL DIRECTOR
Howard S Reynolds
ADDRESS
winthrop
lass
Received and filed DEC 20-1962 19
1YRS
Due To (c)
SIGNIFICANT
OTHER
ARTERIO-SCLEROTIC HEARTH
WITH COMPLETE HEART BLOCK 1 YRS
Was autopsy performed? No
What test confirmed diagnosis ? ....
CLINICAL & XRAYS
5 Was disease or injury in any way related to occupation of deceased ? Na If so, specify
(Signed)
MYRON
N. KING M.D
HEL PLEARHIARTIST
dress) WINTHROP SY MAS Date.
E SIGNATURE)
DEC 17 62
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
DEC
16
1962
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY
AUG9
19 61
to ........
DEC 16
1962
That I attended deceased from
I last saw h Lalive on
DEC
16. 19 62 death is said to
have occurred on the date stated above, at
1249 pm.
INTERVAL
BETWEEN
ONSET AND
DEATH
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
GENERAL CARCINOMATESIS
+METASTASIS TO LUNG
1 YR.
Due To
(b)
CARCINOMA OF RT.
BREAST
TICTIONS
ERTIFICATE
iving
F DEATH *: enter Chan one se or each 5) and (c)
ds not mean d of dying, cart failure, c. It means or compli- aich caused
ejs, if any, ve rise to nuse (a), he under- huse last.
Gions contrib- frath but not to the terminal c dition given
Chapter 137, 54. requires as to print or F
cause or death on eificates, and 8, Acts of elires Physi- rint or type ner signature.
1-59-925686
2 FULL NAME
Mary W (Kammerer) LcDougall
St. (If nonresident, give city or town and State)
(write the word)
(Give maiden_name of wife in full)
Trygon n. King
M. D.
OF MOTHER
Kary Baker
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICEREEVE
:10. DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
6 27.
THROP
RUL: DEC201962 PM
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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