Town of Winthrop : Record of Deaths 1963, Part 29

Author: Winthrop (Mass.)
Publication date: 1963
Publisher:
Number of Pages: 574


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1963 > Part 29


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


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I last saw her alive on


JULY 18


1963


death is said to


have occurred on the date stated above, at 1:10 %?


... m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) ACUTE MYOCARDIAL INSUFFICIENCY


INTERVAL BETWEEN ONSET AND DEATH


2days


Due


(b)


MITRAL STENOSISY RECURITATION


10YRS


€45


(Was deceased a


U. S. War Veteran,


(if so specify WAR)


(If nonresident, give city or town and State)


(write the word)


PARENTS


(City or Town making this return)


contrib- but not terminal a given


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 froin 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.


JUL 191963 At.


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.


PLACE OF DEATH


suffolk


(County)


EPIT


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.


142


2 FULL NAME


Hazel B (Thompson) Magnuson


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


100 Terrace Ave.


St.


58


(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


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Fel .. clc.


9 COLOR


.hite


10 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED married


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


Arnold .. Ma nuson


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


56


AGE


Years.


9


Months.


.. Days


12


If under 24 hours


Hours.


.. Minutes


13 Usual


Housewife


Occupation :


(Kind of work done during most of working life)


14 Industry


or Business :


L.


101.€


15 Social Security No.


16 BIRTHPLACE (City)


(State or country)


17 NAME OF


FATHER


Joh A Thom son


18 BIRTHPLACE OF


FATHER (City)


(State or country)


France


19 MAIDEN NAME


OF MOTHER


wedi uret niely


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


York


York City


-


101 01


21


Informant


(Address)


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Ralph 6. Sirianni (Signature of Agent of Board of Health or other)


Health officer


July, 22, 1963


(Official Designation)


(Date of Issue of Permit)


TVIV


S ICATE


ATH r ne ch (c) mean dying, ailure, means om pli- caused


any, e to (a), der- last. ontrib- ut not rminal given


-


OF ASUENDING COLON


Due To (c)


ULCER OF DUODENUM


OTHER


CHRONIC CHOLECYSTITIS 2


SIGNIFICANT


CONDITIONS


LITHIASIS


HIATUS HELLNHA


Was autopsy performed?


YES


What test confirmed diagnosis ?


AUTOPSY


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


(Signed)


M. D. MYRON N.KING


(PRINT OR TYPE SIGNATURE)


(Address) : 222PLEASANT SI WINTER > Date. 7/20 63


0


Place of Burial or Cremation DATE OF BURIAL


Jul


(City or Town)


19


7 NAME OF


FUNERAL DIRECTOR


ADDRESS


!.. /m.t. . ... A ..


-


Received and filed JUL-22 1963 19


(Registrar)


PARENTS


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,


lif so specify WAR)


(a) Residence. No.


(Usual place of abode)


JULY


19


1963


(Month)


(Dầy)


(Year)


4 I, HEREBY CERTIFY,


6126


963,


to ..


That I attended deceased from


17/19


103


I last saw heRalive on


7/19 /08 Am.


3.


death is said to


have occurred on the date stated above, at .......


INTERVAL


BETWEEN


ONSET AND


DEATH


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


EMBOLISM BOTH PULMONARY


(a)


ARTERIES


15 MIN


Due To POST OPERATIVE RESECTION (b)


IA


r 137, quires int or е ог th on s, and cts of Physi- r type ature.


5686


1


Winthrop Community Ho pital No.


7 3


3 DATE OF


DEATH


- 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.


JUL 2 21563 1 ...


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.


1A


1


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.


143


2 FULL NAME


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


55 Washington Ave.


St.


(If nonresident, give city or town and State)


Length of stay: In place of death .............. years.


months


7


days. In place of residence


40


.years ..


months ..


.days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


July


28


1963


8 SEX


Female


9 COLOR


mite


10 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED .-


Tidowed


4 I HEREBY


CERTIFY,


19.


That I attended deceased from


JULY 21


1963


JULY 28


63


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


EN


July 24


1963,


death is said to


have occurred on the date stated above, at


7:00 Am.


INTERVAL


BETWEEN


ONSET AND


DEATH


12 HRS


Due To


HuberTENSIVE HEART DISEASE


(b)


5YRS


Due To


(c)


HUBERTENSION


OTHER


SIGNIFICANT


CONDITIONS


10YRS


16 BIRTHPLACE (City)


(State or country)


Lass


17 NAME OF


FATHER


William Jone.


18 BIRTHPLACE OF


Unable to obtain


FATHER (City)


(State or country)


Labrador


19 MAIDEN NAME


OF MOTHER


Mary sinnicks


20 BIRTHPLACE OF


Labrador


MOTHER (City)


(State or country)


21


Informant


(Address)


TA Partrouth ave. ucodeor Heats.


Ine& L Brown


Place of Burial or Cremation


DATE OF BURIAL


July


{City or Town) 33


19


7 NAME OF


FUNERAL DIRECTOR


Howard & Lernoldu


ADDRESS


inthrop


JUL 30 1963


19


(Registrar)


PARENTS


(Signed)


Dorothy Cheney appleton


M. D.


DOROTHY Chefey APPLETON


(PRINT OR .TYPE SIGNATURE)


(Address ) 97 Woodside AVE Date .....


7/28


1963


HRON CLASS.


6 1.1


Was autopsy performed ?


No


What test confirmed diagnosis ?


LABORATORYLEKG


5 Was disease or injury in any way related to occupation of deceased ?


If so, specify


No


Received and filed


PLACE OF DEATH


CATE


ATH


e h (c) mean lying, ilure, neans mpli- aused


ny, 10 a), er- st.


ntrib- t not minal given


137, uires nt or : or on , and ts of hysi- type ture.


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Aalph 6 Vivianne (Signature of Agent of Board of Health or other) (B)


Health Officer


July 30, 1963


(Official Designation)


(Date of Issue of Permit)


* VIL


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


Fred M Leonard


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE.


74 Years


3


Months.


21


Days


If under 24 hours


Hours ..


Minutes


13 Usual


Occupation :


Housewife


(Kind of work done during most of working life)


14 Industry


or Business :


Oin home


15 Social Security No.


Beverly


586


Suffolk


(County)


No.


Winthrop Community Hos ital


Marion (Jones) Leonard


S(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)


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


(Month)


(Day)


(Year)


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


(a) ACUTE MYOCARDIAL INSUFICIENCIA


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


inthrop


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER ٢١


5


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 deatis el as those of persons to whom they have given bedside care during a last illness Hom 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 attfierce mindless physician is absent from home when the certificate of death Uted


(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.


01A


1


(County) Winthrop Mass.


(City or Town)


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


STANDARD CERTIFICATE OF DEATH


Registered No.


144


No. Winthrop Community Hospital Aaron Gurwitz AAron Hurwitz A/k/A GURWITZ 2 FULL 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)


(If deceased is a married, widowed of divorced woman, give also maiden name. ) 62 Pleasant St.


St.


2


(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


JULY


30


1963


(Month)


(Day)


(Year)


4 I HEREBY


CERTIFY,


That I attended deceased from


1965


I last saw him).alive on


JULY 30 1963


death is said to


have occurred on the date stated above, at


5.50Pm


UDEATH WAS CAUSED BY : IMMEDIATE CAUSE


CARCINOMA OF the PROSTATE


(a)


WITH. METASTASIS TO Due To RIBS & LUNGS


(b)


1/2YRS.


Due To (c)


OTHER


SIGNIFICANT ARTERIOSCLEROSIS -


CONDITIONS


GENERALIZED


4 YRS


Was autopsy performed? No What test confirmed diagnosis? CLINICAL &X-ray.


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


myron b. King


M. D.


(Signed)


MYRON NAKING M.D


(PRINT OR TYPE SIGNATURE)


(Adl/ress) 222 PLEASANT SI. te JULY 30 63


6 New Monitore COMO -Farmingdale h.l. (City or Town)


Place of Burial or Cremation aug 1 DATE OF BURIAL


7 NAME OF


FUNERAL DIRECTOR


Henry Levine


ADDRESS


Brookline, Mass


Received and filed


JUL 31-1963


19


(Registrar)


PARENTS


21


Informant


(Address)


(AT Gutwitz)


Hurwitz


62 Pleasant 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)


Health effacer


Feely. 36 /4 / 3


(Official Designation)


(Date of Issue of Permit)


1


V


8 SEX


M


9 COLOR


White


10 SINGLE


MARRIED


WIDOWED Widowed


or DIVORCED


10a If married, widovel, of divorcetl


HUSBAND of


Celio Mast


(Give maiden name of wife in full)


(or) WIFE of


INTERVAL


BETWEEN


ONSET AND


11 IF STILLBORN, enter that fact here.


(Husband's name in full)


5/7/63


DEATH


3 YRS


.Years ....


12


AGE89


4


.Months .....


Days


If under 24 hours


Hours.


Minutes


13 Usual


Occupation :


Salesman Mast, MIST


(Kind of work done during most of working life)


14 Industry


or Business :


Metal Work


15 Social Security No. 051-09-1680


Russia


16 BIRTHPLACE (City)


(State or country)


17 NAME OF


FATHER


Abraham Hurwitz


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Russia


19 MAIDEN NAME


OF MOTHER


Leah Siegel


×


20 BIRTHPLACE OF MOTHER (City) (State or country) Al


Russia


Medi


NS FICATE EATH ter one ach id (c) t mean dying, failure, means compli- caused n nehberg porsanctions declined any, ise to (a), inder- last.


contrib- but not terminal n given ·


er 137, equires rint or use or ath on es, and Acts of Physi- or type nature.


926662


PLACE OF DEATH


Suffolk


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


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


PERSONAL AND STATISTICAL PARTICULARS


(write the word)


SEPT 16


59


to ...


JULY 30


KREM


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.


.ELEVEN


TO!


.31 BRK


1


6


IN


RO


JUL 311963 AM


.


1


03


rial permit Health ent.


PLACE OF DEATH


SUFFOLK


1


(County)


WINTHROP


(City or Town)


The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS


(City or Town making this return)


MEDICAL EXAMINER'S CERTIFICATE OF DEATH


Registered No.


145


[(If death occurred in a hospital or institution,


St. ? give its NAME instead of street and number)


No.


78 Locust Street, Winthrop


2 FULL NAME


ELLEN Anne


DEL TERGO


(First Name)


(Middle Name)


(Last Name)


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


78 Locust Street, Winthrop


St


(a) Residence. No.


(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


July


31. 1963


9 SEX


female


10 COLOR


white


11 SINGLE


MARRIED


WIDOWED


DIVORCEMarried


UNKNOWN


(write the word)


(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.) Endocardial fibro-elastosis.


Congestive heart failure.


(or) WIFE of


(Husband's name in full)


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 fo public place ?


(Specify type of place)


Manner of


(How did injury occur ?)


Nature of Injury


While at work?


Was autopsy performed?


6 Was disease or injury in any was related + Aupa ion of deocased ?


(Signed ....


M. D.


Michzel A. Luongo, Boston ( Print or Type Name) 8/1 63


(Address)


Date


19


Holy CrossCemetery Malden


Place of Burial or Cremation.


(City or Town)


DATE OF BURIAL


August 5.


19 .. 63


8 NAME OF


FUNERAL DIRECTOR


Vincent R Rapino


ADDRESS 9 Chelsea St., Last Boston, Mass


Received and filed


AUG 2 1963


19


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


august 2, 1963


A TRUE COPY ATTEST: (Registrar)


(Official Designation)


(Date of Issue of Permit)


/X


12 If married, widowed, or divorced HUSBAND of (Give maiden name of wife in full) Alexander Del Tergo


13 AGE3 Years.


Months ..............


If under 24 hours


Hours


....


Minutes


14 Usual


Occupation :


Housewife


Kind of work done during most of working life)


15 Industry on Business : .........


at home


16 Social Security \No. ... 027-30-0346


17 BIRTHPLACE (City) (State of country) Brookline, Mass.


18


NAME OF


FATHER


Charles J. Egan


19 BIRTHPLACE OF


FATHER (City)


(State or country)


Mass.


Cambridge


20 MAIDEN NAME


OF MOTHER


Alice Ball


21 BIRTHPLACE OF


MOTHER (City)


(State or country)


Mass


Brookline


Alexander Del'ergo (busband)


22


Informant


(Address)


78 Locust St., Winthrop


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit perinit was issued: Capl & Sirianni (3)


100M - 3-62-932695


7 §§ 44-48. 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. Injury


PHYSICIAN - IMPORTANT


[(Was deceased a


U. S. War Veteran,


no


(if so specify WAR)


(If nonresident, give city or town and State)


PARENTS


Yes.


....


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 unrelated to any form pfiniusy963 PM


(2) Board of Health physicians will certify to such deaths a's 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.)"


X


PLACE OF DEATH


SUFFOLK


(County)


BOSTON


(City or Town)


The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH


14.6


146


DITT AT


(City or Town making this return)


Registered No. 06194 [(If death occurred in a hospital or institution, St. ( give its NAME instead of street and number) PHYSICIAN - IMPORTANT


2 FULL NAME


Mary J Collins


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


........


St


Winthrop, Mass.


(City or town and State)


Length of stay: In place of death .......... years ..


.. 1 ... months.2.6days. In place of residence.




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