USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1942 > Part 71
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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 presumahle nature; and (2) under manner, indicate the cir- cumstances leading to medico-legal inquiry. For example: "Hemorrhage spontaneous, of the brain (hasal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)"
DESCRIPTION (for unknown person)
NOTICE TO UNDERTAKERS: No embalming fluid, or any substitute therefor, shall be injected into the body of any person supposed to have met his death by violence, until a permit, signed by the Medical Examiner, has first been obtained .- General Laws, Chap. 38, Sec. 14.
THIS CERTIFICATE CONSTITUTES SUCH PERMIT
M R-302
1
PLACE OF DEATH
Middlesex
(County)
Cambridge
(City or Town)
Holy Ghost Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Cambridge (City or town making return)
Registered No.
1433
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
James S. Keating
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residenoe. No.
42 Loring Road
St.
Winthrop,
Mass.
(If nonresident, give city or town and State)
Length of stay: In hospital or institution.
.. Hospital 4 years 9 months 28
days.
(Before death)
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
(Usual place of abode)
3 SEX
4 COLOR OR RACE
White
Male
(or) WIFE of
6 Age of husband or wife if alive
64
7 IF STILLBORN, enter that fact here.
8
AGE.6.4
Years.
Months.
Days
Usual
9 Occupation :
.Proprietor
Industry
10 or Business:
Restaurant
11 Social Security No ..
....... none
13 NAME OF
FATHER
14 BIRTHPLACE OF
FATHER (City)
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
17
Lotta Keating
Informant
of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)
resided in another city or town at the time of death should be made forthwith and transmitted on Form R2-302 to the clerk
Copies of returns of deaths recorded during the previous month which occurred in your city of town in case the deceased
(State or country)
Ireland
5 SINGLE
(write the word)
MARRIED
WIDOWED Married
or DIVORCED
5a If married, widowed, or divorcedLotta Smith
HUSBAND of
(Give maiden name of wife in full)
(Husband's name in full)
years
if less than 1 day
.Hours ...
......
.. Minutes
12 BIRTHPLACE (City)
(State or country)
Fall River, Mass.
Terrence T. Keating
15 MAIDEN NAME
OF MOTHER
Catherine J. Murray
A TRUE COPY.
Frederick H. Burke
ATTEST :
(Registrar of city or town where death occurred)
DATE FILED
November 10. 1942
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
November
7th.
19.42
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY.
Nov. 1,
, ......
19
42
That I attended deceased
to
Nov. 7.
...
19
I last saw h
im
.alive on
Nov.
6
19 42 death Is said to
have occurred on the date stated above, at.
7:20PM
.m.
Duration
Immediate cause of death
Due to.
Cerebral Hemorrhage
1 wk.
Due to
Arterio Sclerosis
Other conditions.
Cerebral Hemorrhage
(Include pregnancy within 3 months of death)
Major findings :
Of operations.
Date of
Underline the cause to which death should be charged sta- tistically.
Of autopsy.
What test confirmed diagnosis?
20 Was disease or injury in any way related to occupation of deceased ?
If so, specify.
(Signed)
E ............... Robbins.
M. D.
(Address) Somerville, MassDatel1/8/1942
21 PLACE OF BURIAL,
Holy Cross -Malden
CREMATION OR REMOVAL
DATE OF BURIAL
November
(Cemetery)
10, 1942
19
22 NAME OF
FUNERAL DIRECTOR
M. J. Kelly
ADDRESS
E. Boston, Mass.
Received and filed
Des. 7 922
19
(Registrar of City or Town where deceased resided)
50m (e)-1-41-4667
No.
St.
(If U. S.
War Veteran,
specify WAR)
no
yrs.
9
mos.
28
days.
In this community
4
(City or Town)
( Address )
42 Loring Rd., winthrop
Relation, if any
1.938 Physician
R-301 A
1
No. PLACE OF DEATH Suffolk wi County) With (City or Town) 37-
....
Tewks
The Commontoralth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.i
Registered No. § ( If death occurred in a hospital or institution, St. ¿ give Its NAME instead of street aud nuniber)
2 FULL NAME
( Il deceased is a married; widowed or divorced woman, give alao maiden name.)
(a) Residence. No.
37 Juoksbury
(Usual place of abode)
Length of stay: In hospital or Institution
(Before death)
(Specify whether)
years
months
days.
In this community
16 yra. - mos. ve days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female White
4 COLOR OR RACE| 5 SINGLE
MARRIED
WIDOWED
or DIVORCED
( write the word)
married
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
Ja(Give maiden name
mie
Kaufman
( Husband's nathe in fully
6 Age of husband or wife if alive 62 years
> IF STILLBORN. enter that fact here.
8
ÅGE
53
Years
-
Months
-
Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
Housewife
Industry
10 or Business:
11 Social Security No. none
'2 BIRTHPLACE ( City)
(Siate or country )
quevia
13 NAME OF
FATHER
Israel Willen
PARENTS
14 BIRTHPLACE OF
Russia
FATHER (City)
(State or country)
15 MAIDEN NAME
OF MOTHER
Bessie(
cannot be learned
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
17 Informant C William Kaufman Relation, If any (Address) 37 Tewksbury Dr. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was Issued: Www.D. Childress8
(Signature of Agent of Board of Health or other)
Health Officer 11/9/42
(Official Designation) ( Date of Issue of Permity
18 DATE OF
DEATH
11
8
( Month)
(Day)
19
HEREBY CERTIFY,
1934
11/
81
......
Plast saw h .. ........... alive on ....
1942 death Is said to
have occurred on the date stated above, at
9:10 A.m.
Immediate oause of death Camebral Hemorrhage
Essential Hypertension
Due to.
Other conditions ..
( Include pregnancy within 3 months of death)
Major findings:
Of operations.
Date of
Of autopsy
What test confirmed diagnosis? Clinical
IMPORTANT Physician Underline the cause to which death should be charged sta- tistically.
20 Was disease or iptury in any way related to gocupation of deceased ?.
M. D.
(Signed
26 Want Way Due Date 1/8/1942
(Address)
21 montifiore Com/
Woburn
Place of Bugal, Creniation or Removal."
(City or Town)
DATE OF BURIAL
november
10, 1942
22 NAME OF
FUNERAL DIRECTOR.
Manuel quetal
ADDRESS
10- Wash Be,
Received and Aled. 19 ....
( Registrar)
100M-6 -2·42-8855
extracts from the laws on back of certificate. If deceased was a U. S. War Veteran, G. L. Chap. 46. Section 10, requires physicians to Insert a recital to that effect.
Mae Kanfina
1
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
(? so specify WAR)
St.
Winthrop
(If nonresident, give city of town and State)
MEDICAL CERTIFICATE OF DEATH
1942 (Year)
Jan
Ło ..
That
attended deceased from
1942
Duration
IMPORTANT
5 yrs. 0
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after the death of a person whoin he has atteiled during his last illness, at the request of an undertaker or other authorized person or of ans meniber of the family of the deceased, furnisb for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased. his supposed age, the disease of which he died. defined as re- quired by section one, where same was contracted. the duration of his last illness, when last seen alive by the physician or officer and the date of bis death ... Gen. Laws, Chap. 46, Sec. 9.
A' physician or officer furnishing a certificate of death as required by the preceding section or by section forty-five of chapter one bundred and four- teen, shall, if the deceased, to the best of his knowledge and belief, served in the army, navy or marine corps of the I'nited States in any war in which it has been engaged, insert in the certificate a recital to that effect, speci- fying the war, and shall also certify in such certificate both the primary and the secondary or immediate csuse of death as nearly as he can state the same. For neglect to comply with any provision of this section, sucb physician or officer shall forfeit ten dollars. For the purposes of thia sec- tion and of sections forty-five, forty-six and forty-seven of said chapter one bundred and fourteen, the word "war" shall include the China relief ex- pedition and the Philippine insurrection, which shall, for said purposea, he deemed to have taken place hetween February fourteenth, eigliteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexi- can border service of nineteen hundred aud sixtcen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or otber person shall exhume a human body and remove it froin a town. from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until be has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the boily is buried. No such permit shall be issued until there shall have been delivered to sucb board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original internient, by a satisfactory certificate of the attending physician, if any, as required by law. 01 in lieu thereof a certificate as liereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physi- cian who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application miske the certificate re- quired of the attending physician. If death is caused by violence, the medl- cal examiner shall make such certificate. If such a permit for the removal of a liuman body, not previously interred, froin one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such hody has heen sooner obtained hereunder. If the death certificate contains a recital, as required
by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States In any war In which It has been engaged. sucb recital shall appear upon the permit. The board of health, or its agent. upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other urce+ sary information which can be obtained as to the deceased, or as to the mamier of cause of the death, which the clerk or registrar way require .- Cbap. 114. Sec. 45. G. L., ( Tercentenary Edition).
No undertaker or other person shall bury a human body or the ashea thereof which have been brought Into the commonwealth until he has re- crived a permit so to do from the hoard of health or its agent appointed to issue such permits, or if there is no such hoard, from the clerk of the town where the body is to be buried or the funeral is to he held, or from a person appointed to have the care of the cemetery or burial ground in which ibe interment is made. ... Cbsp. 114. Sec. 46. G. L., (Tercentenary Editiou).
Medical examiners shall mske examination upon the view of tlie dead bodies of only such persons as are supposed to have died hy violence. If a medical examiner has notice that there is within his county the hody of such a person, he shall forthwith go to the place where the body lies aud take charge of the same; ... - General Laws, Chap. 38, Sec. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rulea of practice :
(1) Attending phyalcians will certify to such deatha 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 physiolans will certify to such deaths only as those of persons who, though disahled by recognized disease unrelated to any form of injury. have died without recent medical attendance or whose pbref- cian is ahsent from home when the certificate of death is needed.
(3) Medioal Examiners will investigate and certify to all (catba sup- posably due to Injury. These include not only deaths caused directly or in- directly hy traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), therinal, or electrical agents, and deaths following abortion, but also deatha from dlacasa resulting from Injury or infection related to occupation, the sudden deaths of persons not disablad hy recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of deatlı means the disease, or complication which causes death. not the mode of dying, e. g., heart failure, asphyxia, astbenia, etc. Aa principal cause name tbe disease caualng death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Oocupation .- Precise statement of occupation is very im- portant, 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 occupation had been given up or changed ou account of the disease causing death, report the usual occupation prior to illuesa. If the deceased bad retired from business, report the usual occupation prior to retirement. Children not gainfully employed may he returned as at school or at boine. For a woman wbose only occupatiou was that of home housework, write bousework. For a person engaged in domestic service for wages, however, designate the occupation hy the appropriate terms, aa bousekeeper-private faniily, cook-hotel, etc. For a person wbo bad no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
M R-303A
of Death. 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 See reverse side for extracts from the laws relative to the return of certificates of death. N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of name is Schworm
PLACE OF DEATH
Suffolk (County) Winthroh
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
2
Registered No.A.R. § (If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
Francis
Henry Schwarm
2 FULL NAME
(If deceased ista married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ...
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Male
4 COLOR OR RACE
White
8 SINGLE
(write the word)
MARRIED
WIDOWED 1
or DIVORCEHarried
5a If married, widowed, or divorced HUSBAND of ... BerthaHigh ...
(or) WIFE of ..
(Husband's name in full)
60
years
7 IF STILLBORN, enter that fact here.
8
AGE.
72 Years 0
Months ..
.11 Days
If less than 1 day Hours ........... .. Minutes
Uoual
9 Occupation:
Merchant
Industry
10 or Business :.
Shoes
11 Social Security No ....... 011-01-7213
12 BIRTHPLACE (City) ..... LOUIS
(State or country)
Missouri
13 NAME OF
FATHER
Frederick Schwarm
14 BIRTHPLACE OF Germany
FATHER (City) .......
(State or country)
15 MAIDEN NAME
OF MOTHER
Unknown
16 BIRTHPLACE OF MOTHER (City) ...... (State or country)
Germany ...
17
Informant. Bertha Schwarm
Relation, if any Wife
(Address) 227 Court Sted" inthron
I HEREBY CERTIFY that a satisfactory standard certificate of death wag filed with me BEFORE the burial or transit permit was issued:
(Signature of Agent of Board of Hekith or other) Health Officer
11/10/42
(Official Designation) (Date of Issue of/Permit)!
18 DATE OF
DEATH
nor 9
1941
(Month)
(Day)
(Year)
19 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.) natural Causes probably
ʹ
Coronary Stencod with Thrombosis
20 Accident, suicide, or homicide (specify)
Date of occurrence.
19
Where did
Injury occur ?.
(City or Town and State)
Did injury occur in or about home, on farm, in industrial place, in public place?
(Specify type of place)
Manner of Injury ......
Nature of
Injury .........
While at work? Was there an autopsy?
2I Was disease or injury in any way related lo occupation of deceased?
If so, specify
(Signed)
M. D.
(Address)
Date ...
12009
19 .. 542
22 ..
Bellefontaine Cem. St Louis
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
November ..... 12
19.42
23 NAME OF
FUNERAL DIRECTOR .S. Waterman & Sons
ADDRESS
Boston, Mass W.W.N
Received and filed 19
(Registrar)
25m-2-'40-D-729-b
I
......
(City or Town) Cor Paulmer Pleasant, No ...
227 Court
years
months
days.
(If U. S.
War Veteran.
specify WAR)
None
Winthrop.
(If nonresident, give city or town and state)
In this community 13 yrs. - mos .-
days.
(Give maiden name of wife in full)
6 Age of husband or wife if alive.
PARENTS
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required hy section one, where same was contracted, the duration of his last illness, when last seen alive hy the physician or officer and the date of his death . . . Gen. Laws, Chap. 46, Sec. 9.
No undertaker, or other person shall hury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been huried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or If there is no such board, from the clerk of the town where the person dled; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomh other than the receiv- ing tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body 18 buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required hy law to be returned and recorded, which shall be accompanied. in case of an original interment, hy a satisfactory certificate of the attending physician, If any. as required hy law, or in lleu thereof a certificate as hereinafter provided. If there is no attending physician, or If, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or Is In- sufficient, a physician who is a member of the board of health, or em- ployed hy it or hy the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker deslring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which It was removed within thirty-six hours after such removal, unless a permit In the usual form for the re- moval of such body has been sooner ohtalned hereunder. If the death certificate contains a recital, as required by section ten of chapter forty- six, that the deceased served in the army, navy or marine corps of the United States in any war in which It has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be ohtalned as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114. Sec. 45. G. L., (Tercentenary Edition).
No undertaker or other person shall hury a human body or the ashes thereof which have been brought Into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permite, or if there Is no such board, from the clerk of the town where the body is to be hurled or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made. . . . Chap. 114. Sec. 46. G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died hy vloience. If a medical examiner has notice that there is within his county the body of such a person, he shall forthwith go to the place where the hody lies and take charge of the same; ... - General Laws, Chap. 38, Sec. 6.
. . He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; other- wise a description as full as may he, with the cause and manner of death. -General Laws, Chap. 38, Sec. 7.
. . The medical examiner certifies the cause and manner of death to the best of his knowledge and belief.
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 Heaith physicians will certify to such deatlıs only as those of persons who, though disabled hy recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is ahsent from home when the certificate of death 18 needed.
(3) Medicai Examiners will investigate and certify to all deaths supposahiy due to injury. These include not only deaths caused directly or indirectly hy traumatism (including resulting septicemia), and hy the action of chemical (drugs or poisons), thermal, or electrical agents. and deaths following abortion, hut 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 hy a steam railway accident." "Pistol shot wound of the chest with associated hemorrhage, homicidal." "Asphyxiation hy suspension, suicidal." "Syncope while under the influence of ether administered as a surgical anaesthetic." "Fracture of the skull with asso- ciated internal injury sustained under circumstances unknown."
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